Differential Diagnosis for Tooth Pain
The patient presents with tooth pain that started after a dental cleaning, with significant past medical history of hypertension, hyperlipidemia, and diabetes. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Dental abscess or pulpitis: The patient's recent dental cleaning, severe plaque removal, and subsequent tooth pain suggest a possible infection or inflammation of the dental pulp. The pain's progression from pressure to radiating into the jaw further supports this diagnosis.
- Other Likely diagnoses
- Gingivitis or periodontitis: The patient's history of severe plaque and recent dental cleaning may indicate an underlying gum infection or inflammation, which could be causing the tooth pain.
- Dental caries or cracked tooth: The patient's tooth pain could be due to a cavity or cracked tooth, especially if the dental cleaning caused further irritation or exposure of the affected area.
- Sinusitis: The patient's pain radiating into the jaw could be referred pain from sinusitis, especially given the proximity of the sinuses to the upper teeth.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute coronary syndrome (ACS): Although the patient's symptoms are primarily dental, it's essential to consider cardiac causes, especially given his history of hypertension, hyperlipidemia, and diabetes. ACS can sometimes present with atypical symptoms, including jaw pain.
- Trigeminal neuralgia: This condition can cause severe, stabbing pain in the face, including the jaw, and can be a sign of an underlying neurological issue.
- Rare diagnoses
- Temporomandibular joint (TMJ) disorder: The patient's jaw pain could be related to a TMJ disorder, although this is less likely given the recent dental cleaning and plaque removal.
- Osteonecrosis of the jaw: This rare condition, often associated with bisphosphonate use or other medications, can cause jaw pain and could be considered if other diagnoses are ruled out.