Diagnosis of Tooth loss

Tooth loss Diagnosis: Book Excerpts

Diagnosis of Tooth loss: medical news summaries:

The following medical news items are relevant to diagnosis and misdiagnosis issues for Tooth loss:

Diagnostic Tests for Tooth loss: Online Medical Books

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Toothache: Differential Diagnosis
(In a Page: Signs and Symptoms)

Pulp pain (pulpalgia) secondary to dental caries
Traumatic tooth injury (e.g., tooth fracture, restoration fracture, avulsion)

Traumatic occlusion
–Secondary to a new restoration or bruxing
–Galvanic “shock” due to contact by two dissimilar metals (e.g., gold crown with amalgam filling)

Periradicular or periapical pain due to infection of the tooth root or abscess formation
Referred pain from a tooth in the opposing arch
Sinusitis
–Maxillary sinusitis is the most common extraoral source of tooth pain
–All or most teeth in the upper arch may become sensitive secondary to sinusitis

Headache

Temporomandibular joint pain (TMJ)

Trigeminal neuralgia

Barodontalgia from high altitudes

“Dental migraine”
–Associated with patients with depression

Salivary gland disorders (e.g., Sjögren's syndrome, systemic lupus erythematosus)

Otitis media and/or mastoiditis

Angina pectoris

Dry socket (osteitis)

Workup and Diagnosis

History and ear, nose, throat, neck, and cardiac exam and intraoral exam should include mobility tests, percussion, electric pulp test, and thermal tests (ice)
–Tooth mobility is tested by using the back ends of two mouth mirrors on both sides of the tooth
–Reversible pulpitis pain is sharp, intermittent pain of short duration that is provoked by hot, cold, sweets, or biting; the pain does not linger more than a few seconds when the stimulus is removed
–Irreversible pulpitis pain lasts more than 30 seconds upon withdrawal of the stimulus and may occur spontaneously, such as when sleeping
–If an abscess is present, the tooth may be slightly elevated in its socket and mobile
–Periapical abscesses may have systemic findings such as lymphadenopathy or fever
–Toothache or TMJ pain in the morning may occur due to bruxing at night
Transillumination may show fracture lines in teeth
Pulp necrosis will not have any response to stimulation or via the electrical pulp tester
Dental radiographs
Consider sinus X-rays or CT scan if sinusitis likely
Consider referral to dentist (e.g., tooth decay, abscess) or otolaryngologist (e.g., mastoiditis)

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Source: In a Page: Signs and Symptoms, 2004

TOOTHACHE: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

This is simple. Refer the patient to a dentist. If infection is suspected, an antibiotic may be started if there is a delay in getting an appointment. If the dentist cannot find the cause, referral to a neurologist is appropriate.

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Source: Differential Diagnosis in Primary Care, 2007