Differential Diagnosis for Dental Pain

The patient presents with dental pain on the right upper side, which initially improved with antibiotics but recurred after completion of the course. The pain is severe enough to prevent biting down or chewing on the affected side and radiates to the bottom jaw. Given this clinical presentation, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Acute or chronic apical periodontitis or abscess of the affected tooth: This is the most likely diagnosis given the history of a cracked tooth, initial improvement with antibiotics, and recurrence of pain after the antibiotic course was completed. The inability to bite down and radiating pain are consistent with an inflammatory process involving the periodontal ligament and surrounding bone.

• Other Likely Diagnoses

  • Dental pulpitis: The patient's symptoms could also be consistent with pulpitis, especially if the cracked tooth has exposed the dental pulp, leading to inflammation and pain.
  • Periodontal abscess: Although less likely given the history of a cracked tooth, a periodontal abscess could cause similar symptoms, including localized pain and difficulty chewing.
  • Cracked tooth syndrome: This condition, characterized by a crack in the tooth, can cause pain when chewing or biting and might be exacerbated by the initial trauma and subsequent infection.

• Do Not Miss Diagnoses

  • Osteomyelitis of the jaw: Although less common, osteomyelitis is a serious infection of the bone that could occur as a complication of dental infections. It requires prompt diagnosis and treatment to prevent serious complications.
  • Cavernous sinus thrombosis: This is a rare but potentially life-threatening complication of facial infections, including dental infections, that can lead to thrombosis of the cavernous sinus.
  • Ludwig's angina: A severe infection of the submandibular space that can cause significant swelling, pain, and potentially life-threatening airway obstruction.

• Rare Diagnoses

  • Neoplastic processes (e.g., squamous cell carcinoma): Although rare, dental pain can occasionally be the presenting symptom of a neoplastic process in the oral cavity.
  • Trigeminal neuralgia: A condition characterized by episodes of intense pain in the face, which could potentially be triggered by dental issues but is less directly related to the patient's history of a cracked tooth and antibiotic treatment.
  • Eruption cyst or pericoronal abscess: If the patient has a partially erupted tooth on the affected side, these conditions could cause localized pain and swelling. However, the history provided does not strongly suggest these diagnoses.