Case presentation

Ammar Ahmad Fares Marwan Saad

200910225 200820706

 23 year old lady sustained a minor accident while she was driving her car, resulted in a chipped fracture of her upper lateral incisor involving enamel only with sensitivity like symptoms. Her GDP did a composite restoration to repair the tooth, she continued to feel pain from the tooth. The same dentist then root canal treated the tooth with no improvement. Then she was referred to an oral surgeon who performed an apical surgery with no improvement, eventually she had the tooth removed and had an implant inserted with function and esthetic outcome. However, she still continued to suffer from chronic aching pain.

 Deferential diagnoses 1- irreversible pulpitis (Odontogenic pain) 2- Endodontic failure 3- Apical pathology 4- Post operative pain (implant) 5- Neuropathic pain 6- Psychogenic pain

 1- irreversible pulpitis (Odontogenic pain)

- This is the condition where the pulp is irreversibly damaged and cant recover. - Symptoms include pain and sensitivity.

 2- Endodontic failure
- It is charectarized by recurrence of symptoms/infections ( pain and sensitivity) - Endodontic treatment may fail due to many reasons

 3- Apical pathology (apical cyst ) In case of an endodontic failure , infection may spread to the periapical areas causing apical pathology An apical cyst is usually Asymptomatic unless theres a secondary infection which leads to PAIN

 Odontogenic pain Why not ????

 4- Post operative pain (implants)

- Following dental implants placement you may experience some typical discomforts including pain at the implant site and swelling of the gums.

- Why not????

 5- Neuropathic pain
- Damage or infection of the associated nerves may cause pain or aching sensation described in the case - Atypical odontalgia - Trigeminal neuralgia - Idiopathic neuropathy

- Why not ??

 6- Psychogenic pain
- is caused, increased, or prolonged by mental, emotional, or behavioural factors. - Sufferers are often stigmatized, because both medical professionals and the general public tend to think that pain from psychological source is not "real". However, specialists consider that it is no less actual or hurtful than pain from other sources

Psychogenic pain . Why ? The diagnosis of psychogenic pain is made only when all other causes of pain are ruled out . A)patient is young B)suffered a traumatic experience c)other causes of pain ruled out We conclude the pain that the patient is experiencing could be of psychological origins

 Treatment Treatment may include psychotherapy, antidepressants, analgesics, and other remedies that are used for chronic pain in general

 Thank you for listening