Pain is a totally personal experience that cannot be shared and that constitutes one of the main concerns of man. It is the most common symptom by which they come to consult the doctor.
We have already said that it is an experience that cannot be shared, since by applying identical painful stimuli to different individuals, they perceive it differently. We cannot feel exactly the same as another person. There is a great sensitivity to pain on the face and in the mouth. Dentists must differentiate the source of pain.
Here we are going to break down characteristics of different types of pain, focusing mainly on mucosal pain, dental pain and periodontal pain (which comes from the tissues that form the periodontium, which is the area surrounding the tooth).
The mucosa of the oral cavity can be damaged by many factors, such as alcohol, tobacco, certain drugs administered orally or topically, dentinal defects, poorly adapted restorations or prostheses etc., but it can also be affected by local or systemic diseases with repercussion in the oral cavity, producing lesions that will produce pain.
These are injuries that will only hurt when a stimulus is applied. The site of the injury and the place where the stimulus originates are the same. The more stimulus, the more pain. Hence, the pain that is perceived is proportional to the stimulation. An injury will hurt when the pressure we exert on it is in the area of the injury, and the more we press, the more pain we will feel.
We are going to make a classification of the mucous lesions that produce pain:
On the one hand, there are the infections, whether they are viral, fungal or bacterial. Certain iatrogenic injuries can also cause pain, as is the case of trauma, as well as chemical, physical agents. Squamous cell carcinoma (which is a neoplasm), recurrent naphtha, and certain much-macular diseases can be painful.
We found infectious lesions, which can be viral, bacterial and fungal. Nowadays, the prevalence of oral infections is increasing, especially in patients with low immunity, with viral and mystic infections being more frequent than bacterial ones.
There are three groups of viruses that are capable of producing painful vesicular eruptions in the mucosa. They are herpes simplex, herpes varicella zoster and coxsackie. They remain latent in the organism after infection, so that recurrences are frequent, that is, when certain factors called precipitants (such as stress) occur in people who have the virus, the symptoms of the virus return. The illness.
The difference is that in the oral mucosa, when it appears for the first time, there is a great systemic affectation and local pain is one of the main problems, but in relapses it is usually less important. In cold sores, for example, recurrences will not be very painful (with some exceptions).
We have already said that bacterial infections are less frequent, but we must mention the GUNA, acute ulcer necrotizing gingivitis, because of its importance. It is an inflammatory and destructive process of the gums, which causes significant gingival pain. It is a type of moderate or intense pain, which is not caused by any external stimulus, but appears spontaneously, and which is constant.
Regarding mystic infections, that is, fungi, we can assure that the most common fungal infection of the upper digestive tract is candidiasis. There are varieties of candidiasis, being the one that produces pain that is called painful antibiotic tongue (so called because it is common to appear with prolonged use of antibiotics).
Among the iatrogenic causes, the most frequent are injuries, which can be caused by bites, by mechanical irritation of poorly adapted prostheses, etc. It is a type of mild or moderate pain, and will cease when the tissue heals. If the lesion becomes infected, the pain will increase.
Among the chemical agents that produce pain, the one that produces it most frequently is acetylsalicylic acid (aspirin), since in contact with the mucosa, it leads to chemical necrosis, and ulcers occur. And between the physical agents would be the thermal and electrical burns.
Neoplastic lesions of the mucosa, such as squamous cell carcinoma, will only cause pain when they are very advanced and very intense.
Canker sores are one of the most frequent injuries, and annoying during the first days. It is the loss of acute substance, painful, initially necrotic and recurrent. Although the injury persists, it only hurts the first few days.
Among the mucocutaneous diseases, there is lichen planes, with diverse clinical forms, being the only one that hurts the erosive type. If they are very large, they will produce severe pain, which will even hinder the intake of food. Pemphigus vulgaris produces lesions of the bullous type, which will hurt if they are over infected.
The dental pain is one of the most annoying pains that the human being suffers, and is the most frequent cause for which the patients go to the dental clinic.
The sensation of dental pain originates in the receptors located in the pulp (which is endowed with nerve fibers) or dentin.
Cement and enamel are insensitive. When the pain produced for example by a decayed tooth is observed, we see that the location of the pain is not clearly shown, since the patient may feel it referred to other areas. The dental pain presents a great variability in its characteristics and its intensity.
What dental pains can there be?
It is a type of intense pain and lasts a few seconds, and occurs before extreme stimuli. (These stimuli can be cold or hot drinks, acids or sweets etc.) Natural stimuli, such as extreme changes in temperature, can be noticeable in very sensitive teeth, but it does not have to indicate a dent in alteration.
It is a pain that is not very well localized; the patient does not know how to say which tooth hurts, and indicates an area and not a tooth like that affected by the pain. Almost always, the cause of this pain is cavities. A restoration in poor condition, the loss of a filling, abrasions of the enamel etc. These are situations that can make the tooth more sensitive to pain.
The response of the pulp to an external stimulus depends on the intensity of the stimulus applied, and the state of the stimulus. The pulp undergoes modifications with age and other non-physiological situations, etc. and it is difficult to evaluate the state at all times, so the diagnosis of the type of pathological process suffered by the pulp is not simple.
The pain can vary from light to unbearable, it can appear spontaneously without external stimuli, or thermal or chemical stimuli. It can be intermittent, with periods without pain, or continuous. We see, therefore, that it is a type of pain with a wide margin of variability.
In the face of pain in the oral area, the dentist will usually think that it is a dental pain, and it will possibly be the first type of pain that will tend to rule out. The pulpal pain that we can find can be acute or chronic.
Acute pulpal pain may appear spontaneously, as a brief and intense prick that alters the individual momentarily, or to various stimuli, giving rise to the cold and heat, or increasing with heat and decreasing by cold. It can be continuous or intermittent, momentary or maintained. It usually increases at bedtime because it increases the blood pressure of the skull. It ceases when the tooth receives the appropriate treatment or after a while, since after this acute inflammation of the pulp, it dies producing its necrosis.
As in dentinal pain, it is difficult to locate the tooth that suffers pain, especially when the pain is mild.
Chronic pulpal pain is usually the consequence of the continuity over time of an acute alteration. The pain can vary from intense, as in an acute injury, to simply being a discomfort that does not stop.
Mixed pain would occur twice; or when the periodontium has been affected because the acute inflammation of the pulp with involvement of the precipice (the final part of the root of the tooth) is rapid, or when the pulp is affected secondarily (ascending) from a pathological process which occurs initially in the periodontium.
We have already said that practically the first thing that the dentist looks for when the patient refers an oral pain, is an injury or a possible cause that affects the tooth. Tooth decay is the most frequent cause of tooth pain. The dentist will look for carious lesions.
To know if it has affected the periodontium, the patient will refer pain when chewing or under pressure, so the diagnosis will be easier.
When the patient shows great sensitivity to thermal and electrical stimuli (those caused by the dentist), it will generally be an acute pulpitis. If the stimuli are light, increasing the painful response over time, it will be a chronic process.
Anesthetizing the tooth we will see if the pain that was a dental pain stops, we will look for the cause and we will carry out the opportune treatment. As caries, which is usually the most frequent cause of dental pain, progresses, more drastic treatments for the tooth will have to be made (such as endodontic – killing the nerve), so it is important to locate the pain and treat it as soon as possible.