Diagnosis

Here, I would like to describe the diagnosis by the subjective symptom.

The pain that relates to endodontic therapy is divided roughly into the pulpitis (pain in the decayed tooth) and the acute apical periodontitis.

#Cold pain..etc, Pain after decayed tooth treatment

reversible pulpitis

This is the condition where the pulp is inflamed and is actively responding to an irritant. This may include a carious lesion that has not reached the pulp.

Symptoms include transient pain or sensitivity resulting from many stimuli, notably hot, cold, sweet, water and touch. The pulp is still considered to be vital. This means that once the irritant is eliminated, usually by removal of decay and the placement of a filling, that the pulp will return to its normal, healthy state.

irreversible pulpitis

This is the conditon where the pulp is irreversibly damaged. The pulp can not recover from the insult and damage. For example, decay that has reached the pulp of the tooth introduces bacteria into the pulp. The pulp is still alive, but the introduction of bacteria into the pulp will not allow the pulp to heal and it will ultimately result in necrosis, or death, of the pulp tissue.

Symptoms associated with irreversible pulpitis may include dull aching, pain from hot or cold (though cold may actually provide relief) lingering pain after removal of a stimulus, spontaneous pain, or referred pain.

#Occlusal pain

acute apical periodontitis
Intense pain made worse with mastication or percussion

Spontaneous moderate to severe pain. Radiating throb. Prolonged duration, but may be episodic. Swelling ranges from barely perceptible to extensive. Later stages will manifest an elevated temperature.

#Pain after Root-Canal-Treatment

acute apical periodontitis after Root-Canal-Treatment, so-called “Flare-up”

Although about 95% of root canals cause very little to no discomfort after the treatment is completed, there are about 5% of cases which can cause significant pain.  These are commonly referred to as “flare-ups.”  They mostly occur on badly infected teeth, teeth that are extremely irritated, or teeth that have a history of prior treatment.  Sometimes, however, they occur randomly, even on patients that have had several root canals done previously without any problems.

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