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Clinical Practice: The Differential Diagnosis of Dental Pain

Paul J. Flaer, Edward R. Kirsh


In clinical dental practice, patients often present with pain in the oral cavity. While some oral pain may be generalized in nature, the clinician has to consider other factors that involve pain and discomfort. Many symptomatic teeth do not need endodontic treatment – on the contrary, they have undiagnosed occlusal problems, caries, fractures or referred pain. For the teeth needing endodontic treatment, this paper provides several modes of diagnostic methodology. The etiology of endodontic pain from the infected pulp consists largely of the following clinical factors:

1)      Pulpal – Cariogenic microorganisms in the oral cavity exposing dental tubules and direct infection of the pulp chamber and root canals

2)      Periodontium/Alveolar bone – Chronic periodontal disease exposing the apical foramen and/or accessory (lateral) root canals.

3)      Alveolar bone – Cyst or granuloma formation at the apex reflecting chronicity of infection in the development and progression of degenerative changes that constitute periodontal disease and subsequent bone loss.


Defective restorations, interproximal caries, and open proximal contacts acting as food traps create a locus for significant pathology. As a result of toxins released from the action of bacterial colonies on impacted food, plaque, and calculus, there is subsequently substantial inflammation, infection, and pain. Preventing food impaction by maintaining or restoring contacts between the proximal surfaces of adjoining teeth and repairing defective restorations are primary concerns in preventing the morbidity of oral infections. The development of endodontic infections and their sequelae produce active loci of disease that ultimately cause pain and negative involvement of the periodontium, pulpal tissues, and alveolar bone. Socioeconomic factors like lack of financial resources, lack of access to dental offices/clinics, lack of transportation, and cultural factors may limit the patient to receiving only pain-motivated dental care. In the long run, infection, inflammation, and tooth loss negatively impact the overall health of the patient.


Keywords: Diagnosis Endodontic Pain, Endodontic Methodology, Endodontic Therapy

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