Periodontitis

Characteristics of pain syndrome and associated symptoms

In acute periodontitis, patients complain of acute pain that is clearly localized in the area of the causative tooth. A specific clinical sign is discomfort or sharp pain that occurs and multiplies significantly under mechanical load (for example, when biting). Over time, the nature of the sensations changes: the pain becomes constant and begins to radiate along the branches of sensory nerves.

It is important to consider that local inflammatory processes are often accompanied by intoxication syndrome. The patient may experience headache, general malaise, loss of appetite and sleep, as well as chills. Pain sensations may intensify during the performance of routine functions: mandibular movement, talking, breathing, or swallowing.

In chronic periodontitis, the condition may be asymptomatic. In such cases, the reason for seeking medical attention is the presence of a carious cavity, a change in the color, shape, or size of the tooth, as well as an aesthetic defect.

Differential diagnosis of pain in the maxillofacial region

To make an accurate diagnosis, the dentist must differentiate periodontitis from other pathologies. According to the nature of the pain, the following distinctions are made:

• Caries: pain is short-lived and occurs exclusively from the impact of chemical, thermal, or mechanical stimuli.
• Pulpitis: pain is acute, paroxysmal, spontaneous (often occurs at night). Radiation along the branches of the trigeminal nerve (n. trigeminus) is characteristic.
• Acute purulent periostitis of the jaw: pain loses clear localization, spreading from the causative tooth to the adjacent area of the jaw, acquiring a diffuse character.
• Acute osteomyelitis of the jaw: pain syndrome is varied (depends on the extent of bone involvement). Pain can be boring, diffuse, radiating.
• Abscesses and acute lymphadenitis: characterized by aching pain in the affected area, which noticeably increases upon palpation.
• Phlegmons and carbuncles: pain is diffuse and constant, increases over time, and becomes pulsating and throbbing.

Methodology of dental patient examination

Dental diseases are always viewed as diseases of the whole organism, so diagnosis requires the physician to have deep knowledge of related disciplines. The basic principle of a successful examination is a neat appearance and a welcoming attitude, which predisposes the patient to trust.

Examination methods are divided into two large groups:

1. Main methods: begin with proper questioning and attentive listening to complaints. The physician collects the history of the present illness (anamnesis morbi) and life history (anamnesis vitae). Next, an objective examination is performed: external facial examination, palpation, percussion, and probing.
2. Additional methods: include thermodiagnostics, X-ray (radiological) examination, electric pulp testing (EPT), and special tests.

Laboratory tests are prescribed strictly according to indications: cytological, histological, bacteriological analyses, as well as clinical and biochemical blood and urine tests, and oral fluid examination.

All results, diagnosis (according to ICD-10), and the management plan are recorded in the dental patient's medical record (Accounting Form No. 043/U). This is a crucial legal document ensuring continuity of treatment, in which all the physician's actions must be dated.

The role of electric pulp testing (EPT)

EPT is the only non-invasive method that provides an objective idea of qualitative disorders in the dental pulp. The device includes an electrode handpiece and a generator producing current in the operating range of 2–200 µA.

The method is based on determining the excitation threshold of tactile and pain receptors of the pulp when exposed to a direct current of low intensity. The pathophysiological justification of the method lies in the fact that inflammatory processes in the periodontium and dental tissues inevitably lead to a change in the excitability threshold of nerve endings. This occurs both due to direct damage to receptors and as a result of secondary trophic processes. EPT is used not only for differential diagnosis, but also to monitor the effectiveness of ongoing treatment.

Compliance issues in the treatment process

The success of periodontitis therapy largely depends on the interaction between the physician and the patient. In practice, specialists often encounter compliance violations.

At the decision-making stage, difficulties arise due to the patient's refusal of additional examination methods, attempts to "impose" their own opinion on the physician, or a constant search for a "better specialist". At the direct treatment stage, problems are most often associated with attempts at self-treatment, vague execution of medical recommendations, or a complete refusal to continue therapy.

Class and exam questions

What else to study on this topic

• Assessment of the oral cavity hygienic state (Fedorov-Volodkina and Green-Vermillion indices).
• Differential diagnosis of periodontal diseases: catarrhal and hypertrophic gingivitis, periodontitis.
• Specific complaints in pathology of the salivary glands and facial asymmetry.
• Classification of dental diseases based on ICD-10.
• Application of devices for dental surgery and implantology.

Other topics of section "Chapter 16. Methodology of dental patient examination"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.