History of Present Illness (HPI)

The patient is a [insert age]-year-old female who presents with complaints of pain from her upper and lower right wisdom teeth that has radiated to her right ear, starting last night. She has taken over-the-counter (OTC) ibuprofen without any relief. Additionally, she reports that she has run out of her blood pressure medication.

Differential Diagnosis

• Single Most Likely Diagnosis
  • Pericoronitis or wisdom tooth infection: This is the most likely diagnosis given the patient's symptoms of wisdom tooth pain radiating to the ear, which is a common referral pattern for dental pain. The lack of response to ibuprofen could indicate a more severe infection.
• Other Likely Diagnoses
  • Temporomandibular joint (TMJ) disorder: The pain in the ear could also be related to TMJ dysfunction, especially if the patient has been clenching or grinding her teeth due to the wisdom tooth pain.
  • Dental abscess: An abscess related to the wisdom tooth could cause severe pain that does not respond to OTC pain medications and could radiate to the ear.
  • Hypertension-related symptoms: Given that the patient has run out of her blood pressure medication, uncontrolled hypertension could potentially cause headaches or other symptoms that might be confused with or contribute to her current condition.
• Do Not Miss Diagnoses
  • Trigeminal neuralgia: Although less common, this condition can cause severe, stabbing pain in the face, including the teeth and ear, and would be a critical diagnosis not to miss due to its significant impact on quality of life.
  • Otalgia of non-dental origin: The ear pain could have a non-dental cause, such as an ear infection (otitis media or externa), which would require a different treatment approach.
  • Temporal arteritis: This condition, although rare in younger populations, can cause severe headaches and jaw claudication and is a diagnosis that should not be missed due to the risk of vision loss if left untreated.
• Rare Diagnoses
  • Eagle syndrome: This is a rare condition where an elongated styloid process or calcified stylohyoid ligament causes facial and ear pain, which could potentially be considered in the differential if more common causes are ruled out.
  • Glossopharyngeal neuralgia: Similar to trigeminal neuralgia, this is a rare condition that causes sharp, stabbing pain in the tongue, throat, ear, and jaw, and would be an important, though less likely, diagnosis to consider.