Sunday, September 18, 2011

Patient s complaints

Listening carefully to the patient’s description of his/her symptoms can provide invaluable information. It is quicker and more efficient to ask patients specific, but not leading, questions about their pain. Examples of the type of questions which may be asked are given below.
1. How long have you had the pain? 
2. Do you know which tooth it is? 
3. What initiates the pain? 
4. How would you describe the pain?
Sharp or dull Throbbing Mild or severe Localised or radiating
5. How long does the pain last? 
6. Does it hurt most during the day or night? 
7. Does anything relieve the pain?

It is usually possible to decide, as a result of questioning the patient, whether the pain is of pulpal, periapical or periodontal origin, or if it is non-dental in origin. As it is not possible to diagnose the histological state of the pulp from the clinical signs and symptoms, the terms acute and chronic pulpitis are not appropriate. In cases of pulpitis, the decision the operator must make is whether the pulpal inflammation is reversible, in which case it may be treated conservatively, or irreversible, in which case either the pulp or the tooth must be removed, depending upon the patient’s wishes. If symptoms arise spontaneously, without stimulus, or continue for more than a few seconds after a stimulus is withdrawn, the pulp may be deemed to be irreversibly damaged. Applications of sedative dressings may relieve the pain, but the pulp will continue to die until root canal treatment becomes necessary. This may then prove more difficult if either the root canals have become infected or if sclerosis of the root canal system has occurred. The correct diagnosis, once made, must be adhered to with the appropriate treatment. In early pulpitis the patient often cannot localise the pain to a particular tooth or jaw because the pulp does not contain any proprioceptive nerve endings. As the disease advances and the periapical region becomes involved, the tooth will become tender and the proprioceptive nerve endings in the periodontal ligament are stimulated