Differential Diagnosis for Severe Tooth Pain
The patient's symptoms and history suggest several possible diagnoses. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Acute pulpitis: This is the most likely diagnosis given the patient's severe tooth pain, recent dental cleaning, and pain characteristics (exacerbation with pressure and eating). The patient's prolonged absence of dental care increases the risk of pulpitis.
- Other Likely diagnoses
- Dental/periodontal abscess: The patient's symptoms and history of poor dental care make an abscess a possible diagnosis. The presence of hypertension, hyperlipidemia, and diabetes mellitus may also increase the risk of infection.
- Cracked tooth syndrome: This condition is a possible cause of the patient's tooth pain, especially if the recent dental cleaning caused micro-fractures in the tooth.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Trigeminal neuralgia: Although less likely, trigeminal neuralgia is a serious condition that requires prompt diagnosis and treatment. The patient's pain characteristics and comorbidities make it essential to consider this diagnosis.
- Referred pain from sinusitis: Sinusitis can cause referred pain to the teeth and face, and given the patient's history of hypertension, hyperlipidemia, and diabetes mellitus, it's crucial to rule out sinusitis as a possible cause of the pain.
- Rare diagnoses
- Other rare conditions, such as Eagle syndrome (stylalgia) or cardiac-related tooth pain, are unlikely but should be considered if the patient's symptoms do not respond to treatment or if other diagnoses are ruled out. However, these conditions are not directly related to the patient's symptoms and history, making them less likely.