From Volume 42, Issue 7, September 2015 | Pages 622-630
Pain is one of the major reasons that lead patients to seek dental care. For the majority of patients, the pain is of odontogenic origin, as a consequence of dental disease. The timely diagnosis and management of dental pain is an essential component of dental care, and this article reminds readers of the common presenting symptoms of simple dental pain, diagnoses and pragmatic management.
Dental or odontogenic pain is common. In the Adult Dental Health Survey 2009, 9% of patients reported pain at the time of examination, and 8% reported pain frequently in the preceding 12 months and, for some, pain is the primary reason for attendance.1 As with all patients, a thorough history of symptoms should be taken from the patient, along with the medical and social history. The responses may then be interpreted in light of the clinical examination. As with all histories, a systematic approach helps to avoid missing important detail, and elicits the key factors in the history.
Pain of odontogenic origin might be divided into three categories:
Each condition produces characteristic and consistent pathological changes, for example appendicitis always follows the same process so, as a consequence, any condition will present with a range of symptoms and signs that are specific to that condition. Whilst there may be overlap, or a combination of symptoms or multiple conditions, the basic premise holds firm for all conditions. This concept was outlined by Osler in the early 1900s with his advice to colleagues and summarized as ‘listen to the patient – he is telling you the diagnosis’.2 This advice still holds true over a century later, and is based on the principle that symptoms reflect pathology. The corollary from this is that, without a diagnosis, treatment should not be instituted.
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