Differential diagnosis of pulp hyperemia, acute limited pulpitis and acute deep dental caries

Clinical signs

Diagnosis

Acute pulpitis

Acute or exacerbation of chronic apical periodontitis

Acute maxillary sinusitis

Neuralgia of trigeminal nerve (V)

Character of pain

Sharp spontaneous, throbbing pain, increases at night and from all kinds of irritants, has irradiation of pain following branches of nerve trigeminal

Constant dull pain, increases during biting

Constant dull and throbbing pain in the maxilla, increases when head is bowed down

Throbbing, exhausting pain that appears and disappears spontaneously.

Provoking factors of pain

Temperature stimuli provoke pain, after elimination of irritant pain is gradually decreased.

Mastication and biting on the tooth

Any irritants don’t initiate or relieve pain. Pain could start when biting on teeth that are localized close to inflamed part of maxillary sinus.

Mechanical and temperature stimuli that do its action in triggering zones.

Additional clinical signs

Probing of carious cavity bottom is sharply painful. There is no disclosure of tooth cavity. Percussion is painful in the course of purulent pulpitis.

Probing of carious cavity bottom is painless; tooth cavity is disclosed; percussion cause sharp pain; muco-buccal fold is swallowed and hyperemic near causative tooth

Feeling of nasal congestion; difficulty of nasal breathing through appropriate half of nose; mucous or pus discharge from nose.

Hyperemia of face, tearing, increase of salivation. Reflector contraction of chewing muscle.

General state of patient’s health

Headache and weakness is possible.

Headache, weakness, loss of appetite, raise of temperature is possible.

Increase body of temperature total weakness, headache that increases during cough sneezing, tilting of the head. Quick fatigue (tiredness).

General state of organism is not changed. But during attack of pain patient freezes in troubled pose, and afraid to move.