Differential Diagnosis for Tooth Pain
- Single most likely diagnosis
- Acute pulpitis or reversible pulpitis: The patient's symptoms of severe tooth pain with pressure, especially when eating or pushing down on the tooth, are consistent with pulpitis. The recent dental cleaning and plaque removal may have caused irritation or inflammation of the pulp, leading to the worsening pain.
- Other Likely diagnoses
- Dental abscess (early stage): Although the exam does not show signs of abscess or drainage, it's possible that the patient is in the early stages of developing an abscess. The severe pain and pressure on the tooth could be indicative of an underlying infection.
- Periodontal abscess: The patient's history of poor dental hygiene (5 years since last cleaning) and significant plaque buildup increases the risk of periodontal disease. A periodontal abscess could cause severe pain and pressure on the tooth.
- Cracked tooth syndrome: The patient's recent dental cleaning and possible trauma to the tooth during the procedure could have caused a crack in the tooth, leading to pain and sensitivity.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Trigeminal neuralgia: Although rare, trigeminal neuralgia is a condition that can cause severe, stabbing pain in the face, including the teeth. It's essential to consider this diagnosis to avoid missing a potentially serious condition.
- Osteonecrosis of the jaw: The patient's history of taking aspirin and possible use of other medications (e.g., bisphosphonates) increases the risk of osteonecrosis of the jaw. This condition can cause severe jaw pain and tooth pain.
- Sinusitis or sinus infection: The patient's symptoms of pressure and pain in the tooth could be referred pain from a sinus infection. Sinusitis can cause pain in the upper teeth and face.
- Rare diagnoses
- Eruption cyst or pericoronal abscess: Although rare, an eruption cyst or pericoronal abscess could cause severe pain and pressure on the tooth, especially if the patient has a partially erupted tooth.
- Odontogenic tumor: A rare possibility, odontogenic tumors can cause tooth pain and pressure. However, this diagnosis would require further evaluation and imaging to confirm.