Sore mouth

Introduction The front wall of the mouth is the lip, which is ruptured to the outside through the mouth; the posterior pharyngeal door and the oropharynx are continued; the cheeks are on both sides; It consists of sputum and sublingual area, respectively. Oral organs include soft tissues such as the lips, cheeks, tongue, sputum, sputum, and mouth, and hard tissues such as the upper and lower jaws, teeth, and temporomandibular joints. Oral pain is the pain that occurs in the above oral organs. It is the most common symptom in the clinical department of stomatology, and it is often the main reason for patients to seek medical care.

Cause

Pain is caused by irritation of body tissue damage. The irritant that causes pain is called a painful substance. The pain-causing substance is released during tissue damage, such as acetolcholine, serotonin, histamine. Bradykinin and its like peptides, potassium ions, hydrogen ions, and acidic metabolites released during tissue damage. When these substances directly excite the pain receptors of the nerve endings, the impulses along the trigeminal thalamus bundle, up to the level of the pons and the side of the spinal thalamus, enter the cerebral cortex and then return to the first sensory area and cause pain. The patient's response to pain is determined by two factors, one is the patient's pain threshold; the other is the patient's sensitivity to pain. Both are different in every patient.

Primary oral pain is caused by direct mechanical or chemical stimulation of one or more pain receptor system located in the mouth causing pain in the oral tissue. Secondary oral pain is pain in the oral tissue caused by stimulation of a part of the pain transmission pathway. For example, intracranial tumors compress the central part of the trigeminal nerve conduction and cause pain in the peripheral branch distribution area.

Involved oral pain is the pain that is located away from the site of pain and the site of pain. Upper tooth pain caused by dental lesions as follows. Cardiac pain can involve the left lower jaw. The mechanism involved in pain may be that the impulse of conduction at the diseased part has “transmission crossover” and causes the central “misunderstanding”.

(1) Primary oral pain

1. The pain of the tooth itself rickets, pulp congestion, pulpitis, cracking, dentin hypersensitivity, etc.

2. Periodontal disease apical periodontitis, alveolar abscess, periodontal abscess.龈 papillitis, pericoronitis and so on.

3. Diseases affecting oral skin, facial mask, periosteum and fascia such as various contusions, contusions, burns, mouth ulcers, cellulitis, abscesses, fractures, osteomyelitis, acute mumps Oral tumors and systemic diseases such as nutritional deficiencies, endocrine and metabolic disorders, blood diseases, poisoning, allergies and other damage to the mouth.

4. Diseases of the jaw joints Temporomandibular joint disorder syndrome.

5. Muscle disorder diseases Myositis, tendon and myofascial pain syndrome.

(2) Secondary oral pain

1. Trigeminal neuralgia, glossopharyngeal neuralgia, etc.

2. Intracranial tumors, nasopharyngeal tumors, aneurysms, etc.

(3) Involving sexual pain

1. Dental disease

2. Nasal and paranasal sinus disease

3. Heart disease

Check

Related check

Oral endoscopic oral X-ray examination

(1) Medical history

According to the complaint, Ask about the history and symptoms of the symptoms in detail.

1. Understand the pain area, such as trigeminal neuralgia, the corresponding branch dominates the area of ​​pain. Pericoronitis occurs mostly in the area of ​​the mandibular wisdom teeth. In acute pulpitis, patients often cannot locate themselves.

2. Distinguish the nature of pain Sharp and spontaneous pain is most common in acute pulpitis, very acute periarthritis, and also in acute periodontal abscess, pericoronitis, trigeminal neuralgia, acute maxillary sinusitis. Spontaneous dull pain is common in chronic sputum papillitis. Exciting pain is more common in wedge-shaped defects, dentin hypersensitivity and 110Ill0” caries, etc., only when physical or chemical stimulation occurs in sensitive areas or lesions, pain occurs, and the pain disappears after stimulation removal. Occlusal pain often occurs in dental trauma, acute periapical periodontitis, and acute periodontal abscess.

3. Understanding the course of pain Trigeminal neuralgia is a transient electric shock, and there is no discomfort during the intermittent period of pain. Acute pulpitis manifests as spontaneous pain, nocturnal pain, and paroxysmal reflex pain. The pain of chronic submandibular gland inflammation and ductal stones in the submandibular gland is associated with eating.

(2) Physical examination

1. Local examination Check the oral and maxillofacial lesions for pain, such as tooth tissue defects, ulcers, trauma, swelling, etc.

2. Systemic examination In particular, whole body skin examination is meaningful for psoriasis and riboflavin-deficient oral pain. In addition, the tendency of skin bleeding has an auxiliary value for the diagnosis of thrombocytopenic purpura and leukemia. The rash of cases such as scarlet fever or measles is more diagnostic.

(3) Laboratory examination

1. For patients with oral and maxillofacial inflammation, blood examination, especially white blood cell count and classification examination, have diagnostic value for diagnosing inflammation.

2. Hematological examination and some specific examinations such as serum and Kang's reaction for patients with oral diseases caused by systemic diseases are helpful for the diagnosis of diseases such as blood diseases and syphilis.

Differential Diagnosis

(a) rickets

Rickets are hard to make teeth The organization gradually destroys a disease in which disintegration forms a substantial defect. Clinically, according to the degree of tooth destruction, it is divided into shallow enamel (enamel ), middle (dentin ), and deep (dental deep ). Shallow tooth destruction is limited to the enamel layer, which is in ink immersion or white ochre in the gap gap or adjacent surface. Patients generally have no complaint symptoms. The lieutenant destroys the shallow layer of dentin and forms a cavity. The patient is sensitive to a sweet and sour diet. The cold and overheated diet can also produce a sore feeling. The cold stimulus is particularly noticeable, but the symptoms disappear immediately after the stimulation is removed. Deep squats deep in the dentin. A deep cavity can be seen clinically. Hot and cold stimuli and food are embedded inside the cavity, causing pain. When the stimulus is removed, the pain stops and the patient has no spontaneous pain, which can be distinguished from pulpitis. There is pain when measuring the hole with a probe. Judging the sputum located on the adjacent surface of the tooth and near the neck is sometimes difficult, and X-ray examination is needed to assist the diagnosis.

(b) Pulpitis

Pulpitis is due to bacteria and the toxins produced by the cavity through the cavity, tooth trauma, abrasion or periodontal infection Inflammation caused by retrograde invasion of the pulp through the apical foramen. According to the characteristics of clinical features, it is divided into acute pulpitis, chronic pulpitis and retrograde pulpitis.

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