Pulpitis: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:PMC3548354 JCD-16-83-g001.png|thumb|X-ray showing well-defined radiolucency of mesial and distal roots of symptomatic first lower left molar consistent with irreversible pulpitis and associated apical periodontitis.]] | |||
*X- | ===Workup==== | ||
* | *Consider pain X-rays | ||
**Not typically performed in the ED; may be performed upon referral | |||
===Diagnosis=== | |||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
Revision as of 21:40, 2 December 2021
Background
Dental Numbering
- Adult (permanent) teeth identified by numbers
- From the midline to the back of the mouth on each side, there is a central incisor, a lateral incisor, a canine, two premolars (bicuspids), and three molars
- Children (non-permanent) teeth identified by letters
- Common landmarks:
- 1: Right upper wisdom
- 8 & 9: Upper incisors
- 16: Left upper wisdom
- 17: Left lower wisdom
- 24 & 25: Lower incisors
- 32: Right lower wisdom
Clinical Features
- Reversible Pulpitis
- Duration of pain is short (seconds)
- Associated with noxious stimuli (usually cold or heat, can also be elicited by sweat and sour)
- Irreversible Pulpitis
- Duration of pain is long (hours) and intense
- Associated with noxious stimuli or may occur spontaneously
Differential Diagnosis
Dentoalveolar Injuries
Odontogenic Infections
- Acute alveolar osteitis (dry socket)
- Acute necrotizing ulcerative gingivitis (trench mouth)
- Dental abscess
- Periapical abscess
- Periodontal abscess
- Ludwig's angina
- Pulpitis (dental caries)
- Pericoronitis
- Peritonsillar abscess (PTA)
- Retropharyngeal abscess
- Vincent's angina - tonsillitis and pharyngitis
Other
Evaluation
Workup=
- Consider pain X-rays
- Not typically performed in the ED; may be performed upon referral
Diagnosis
- Clinical diagnosis
Management
- Short term management with local anesthetics
- Antibiotics controversial for dental pain alone without evidence of infection
- Antibiotic choices: Penicillin VK or clindamycin
- Definitive therapy with root canal or extraction (for irreversible pulpitis)
Disposition
- Discharge with dental follow-up