Patient: Good morning, Doctor!

Doctor: Hello! How can I help you?

Patient: I am one of your patients and I would like to make an appointment with you, preferably for today. I have been suffering from a toothache for the last two days. Two days ago the pain was bearable, but yesterday I had problems with falling asleep because of it. I had to take some painkillers.

Doctor: I can see you, but only after I see all my patients. This will be around 7.30 p.m.

Patient: I see. Thank you very much. I will be there around 7.30.

After a few hours

Patient: Good evening, Sir. I’ve come as it was scheduled.

Doctor: Hello, please come into my office.

After a while

Doctor: On the phone you have said that you’ve been in pain for two days.

Patient: Yes, but yesterday the pain was so strong that I had to take a pill to fall sleep.

Doctor: And now, are you in pain?

Patient: Right now it’s not hurting, but it was painful right after dinner.

Doctor: And can you tell me which tooth is painful?

Patient: I’m sure it’s on the right side, but I do not know whether it’s the upper or lower one, it’s probably somewhere in the back.

Doctor: Well, in the case of inflammation of the pulp, because I’m quit certain it is the inflammation, oftentimes you can not locate the tooth which triggers the pain. Please tell me if it hurts you while drinking cold liquids, or while biting?

Patient: No, it doesn’t. That’s strange, but it hurts me only, without any reason.

Doctor: I’ll check the response of your teeth to cold stimulus. If you feel any pain, please let me know.

Patient: No, nothing hurts. I just feel the cold.

Doctor: And now when I’m knocking on it. Can you feel anything strange in any of your teeth?

Patient: No, I do not feel anything unusual.

Doctor: Well, we’ll have to wait until tomorrow. Actually you have had all your premolars and molars on the right side filled and in fact each of them may be the trigger of the pain.

Patient: Oh, I would prefer to do something with it today, but if we have to wait until tomorrow, so let it be. I hope I’ll be able to stand the pain somehow.

Doctor: Well, unfortunately, we must do so, because we do not know which tooth is a problem.

Patient: So what time am I seeing you tomorrow?

Doctor: Just like today, at 7.30.

Patient: So I’ll see you tomorrow!

Doctor: Goodbye!

Next day

Patient: Good evening, Doctor.

Doctor: Good evening.

Patient: I think I know which tooth is a problem. While I was eating dinner one of the teeth was hurting me a little while biting.

Doctor: Oh, that would be good. Maybe will be able to help you tonight. Which tooth is it?

Patient: It’s the big bottom one.

Doctor: I’ll check it just in case. Is it hurting you while I’m knocking on it?

Patient: Ouch! It is hurting.

Doctor: So I’ll try to remove the filling. If it starts hurting while filling removal just let me know.

After a while

Patient: Doctor, it started to hurt and does not want to stop.

Doctor: Well, now I’m sure that’s the tooth. Unfortunately, it qualifies for the root canal treatment.

Patient: Will you start the treatment tonight?

Doctor: Yes. I have already applied some anesthesia. It will be the same situation as with that top seven, which I treated for you last year. 

Patient: I remember exactly what you’re talking about.

Doctor: Well, let’s get to work now!

VOCABULARY PRACTICE

Read the text below. Complete it with the words from the table

Differential diagnosis is the process of weighing the probability of one disease 1) _________ that of other diseases possibly accounting for a patient’s illness or condition. The differential diagnosis of dental pain can be the ultimate 2)____________. Each patient presents with a different set of signs and symptoms, and from these 3)_________ the dentist must identify the disease, the etiology, and then recommend appropriate treatment. This process becomes complicated when multiple problems are present at the same time. Eliminating the most obvious cause first will usually lead the way to diagnosis of secondary causes of the patient’s 4)_______________.

The key to establishing a chief complaint is to use LOVE scheme. LOVE is an acronym for: Listen, Observe, Verify, and Eliminate and helps the dental staff in establishing the real cause of toothache. The first step is to “Listen to your patients. Let them tell you the story of their illness and they will give you the diagnosis” From this history the onset, duration, and type of pain should be documented. Patients will also 5)___________ a lot if you observe their hand gestures and body language. They will frequently place a hand on the area in 6)____________, and you can learn to read the 7)________________ of the pain in their eyes. If you ask patients if they are cold sensitive, they will invariably say yes. But if you ask them if the pain to cold is recent and associated with their current problem, many times the response will be no; and that their teeth are cold sensitive 8)______________. Once you have all of the information, it helps to eliminate the irrelevant facts.             

Clinical and radiographic examinations provide much of 9)____________information, but testing the teeth is essential for confirming cause and effect. Basing a treatment decision on clinical and radiographic examination alone is not allowed because it may lead to frequent 10)____________. Having a patient point to the tooth that hurts is often misleading, due to the 11)_____________ nature of the innervation in the head and neck. It is common for a tooth to refer pain to another tooth.

Classic tests to help differentiate odontogenic from nonodontogenic pain12)_____________ thermal, electric pulp tests, percussion, palpation, biting, and transillumination.

Look at the definitions below. Try to guess what type of test is being described. One dash stands for one letter

1) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ – is a test which can reveal problems in your teeth that can’t be seen with the naked eye or with X­‍‑rays. Decay appears in the image as cloudy shadows, while healthy tooth structure is lighter, as light shines through it more easily. It is especially effective in detecting decay under old fillings. It can also reveal fine cracks in the teeth.

2) _ _ _ _ _ _ _ test checks tooth reaction and response by using hot or cold stimuli.

3) _ _ _ _ _ _ _ _ _ test during which the tooth is felt with gloved finger of a dentist. This is where the dentist feels the mucosa overlying the roots to see if any swelling is present. If a tooth is particularly infected or an abscess has formed, then there is likely to be some level of inflammation in the bone surrounding the tooth that the dentist can feel.

4)   _ _ _ _ __ _ _ _ _ test, this is where the dentist taps gently on patient’s tooth with either a finger or the handle of one of the instruments in order to try and identify the tooth causing the problems.

Lesson 69 - answers