[Acute and chronic toothache].

Abstract

Toothache occurs as a result of pulpal and periodontal diseases. Due to the nature of their innervation pain is the only means for both pulp and dentine to react to all kinds of external stimuli. The actual mechanism of sensory transmission, however, has not been clarified, yet. In contrast to this, the innervation of the periodontium offers a wide range of mechano-sensitive receptors. Chronic dental pain is mainly the result of inflammatory reactions. Nerve sprouting, summation, convergence in the trigeminal system and regional inflammatory conditions modulate the local pain process, thus complicating diagnosis. The differential diagnostic clarification with regard to neuralgiform and ENT-diseases therefore requires special care with case history and status. Although there have been advances in pain research over the last few years, no fundamental development in dental diagnosis has been brought about, yet. Probing, sensitivity- and percussion testing as well as x-ray exposure are still the most important diagnostic tools for the dental practitioner.