Ignorance Of Dental Pain
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Oral disorders such as dental caries and periodontal disease are worldwide public health problems. The “Global Burden of Oral Conditions in 1990–2010” report showed that oral conditions continue to be highly prevalent, affecting about 3.69 billion people. In this report, untreated dental caries in the permanent dentition was identified as the most common of all the evaluated disorders, having the highest worldwide disease load, affecting 35% of all age groups. Severe periodontitis was the sixth most prevalent condition (11% of world population) and untreated caries of the primary dentition was the tenth (9% of world population). Severe tooth loss was the 36th most prevalent condition, affecting 2% of the world’s population]. A number of studies from around the world state that 60–90% of schoolchildren suffer from dental caries.
In Latin America, dental caries is among the most frequent untreated health conditions among preschoolers, schoolchildren, and adolescents, who have limited access to restorative dental treatment. In Mexico, dental caries is the primary public oral health problem; for example, at 12 years of age between 70 and 85% of schoolchildren exhibit caries in the permanent dentition, with a high prevalence of untreated cases. Dental caries is also the main cause of dental death in various age groups, presenting a serious challenge to the oral healthcare system due to high care costs.
Oral and dental diseases can cause pain, suffering, functional deterioration, and diminished quality of life. The high cost of treatment constitutes a substantial burden to the national health system and for individual households. Families often opt to pay directly for dental care in an effort to maintain adequate oral health among household members. In developed countries, oral health treatment represents from 5 to 10% of health expenses. This treatment is unavailable or extremely limited in many developing countries, where affected teeth are often not treated or merely extracted, making them the main source of pain. For decision-makers in different countries, especially in the “developing” ones where the burden of disease is high, it is necessary to consider oral health as a priority and having recent epidemiological data is essential.
The experience of pain, considered a normal consequence of organ or system disorders, is a ubiquitous public health concern. Untreated dental caries generally leads to dental pain. Although dental pain can seriously affect peoples’ daily life, negatively affecting quality of life, few epidemiological studies on oral health include questions on dental pain. Orofacial pain, and especially dental pain, can cause sleep loss, diminished work effectiveness or academic performance, absence from school or work, weight loss, and avoidance of certain foods. Some researchers treat it as a predictor of dental health service use (usually curative or emergency). In this type of care, teeth receive nonregressive treatments that can predispose them to loss over time; it can also raise the probability of an edentulous old age.
General medical practitioners are often called upon to manage acute dental pain in emergency situations, for example, out of hours or in rural Australia, where it may not be possible for a dentist to provide immediate treatment. Common acute oral problems are usually easy to diagnose. Simple management can alleviate pain and further discomfort until a dentist can be called upon.
Most problems can be identified by the history and examination. Several dental conditions have typical symptoms with different types of pain.
Which Tests Can Assist In Diagnosis?
There are several simple tests that may assist in diagnosis of dental pain.
Pulp Sensitivity Test
Dry ice, or an ordinary ice stick (made in a plastic or glass tube), is placed on the cervical third (neck region) of the tooth crown. A response to the stimulus indicates that the pulpal tissue is capable of transmitting nerve impulses. No response may indicate pulp necrosis.
Using an instrument handle, the tooth is tapped in the longitudinal axis. A painful response suggests possible periapical inflammation.
Placing a fine, blunt probe gently into the gingival sulcus surrounding the tooth enables the health of the gingival tissues to be assessed. Bleeding and/or sulcus depths greater than 3-4 mm indicate gum disease.
Holding a tooth firmly on the buccal (cheek) and lingual sides between the fingers enables mobility to be assessed. All teeth have a small amount of mobility (
Careful palpation around the area of concern may reveal tenderness and the type and extent of swelling.
If it is possible to obtain a screening radiograph, such as an orthopantomograph (OPG), this may assist in the diagnosis and localisation of the cause of the pain. The radiograph should show clearly the apical and periapical structures of teeth and associated tissues. The relationship of the maxillary molars and premolars to the floor of the maxillary sinus can be examined, and radiographs may reveal recurrent caries or periapical radiolucencies associated with an established infection
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Article compiled by Apple Tree Dental