Page 827 - My FlipBook

DENTAL NEURALGIA. 837

caused by the expansion in the pulp-cavity of gas arising from decom-
position of pulp-tissue, in which case warm water causes an increase of
pain by increasing the expansion. In the later stages of acute disease
as the pulp approaches a moribund condition its sensibility is lessened,
and is finally lost.
The DIFFERENTIAL DIAGNOSIS between diseases of the dental pulp
and the different forms of pericementitis is usually easily made out, if it is
remembered that the peridental membrane is the organ of the tactile
sense for the tooth. If the peridental membrane is inflamed, the tooth is
sensitive to the touch, and is not sensitive to reasonable thermal changes
;
while in acute and painful diseases of the pulp the tooth is not sensitive
to the touch, but is very sensitive to changes of temperature. Reflected
or radiating pains do not occur in diseases of the peridental membrane
without the presence of a tooth that is sore to the touch. In case of
reflected pain from disease of the pulp the tooth is not sore to the touch.
In Degenerations of the dental pulp its sensibility to thermal change
is generally markedly diminished. In some cases I. have noticed that
painful sensations came on some minutes after excitation by thermal
change, as though the pulp was incapable of the usual quick response.
This may be true even though the pulp is in a condition to cause very
severe pain, and under these conditions I have thought that there was
a greater tendency to reflected pain. In such cases unusual difficulty
is encountered in the differential symptomatology between neuralgia and
reflected pain from the dental pulp. The greater tendency to reflected
pain in these cases is probably on account of the comparative insensi-
bility of the pul]) to local disturbances.
Dental Neuralgia is a form of the affection which has its immediate
exciting cause in some disease of the dental pulp. This should not be
confounded with the reflected pains spoken of above. In many cases,
however, a differential diagnosis is difficult to arrive at, on account of
the close similarity of the symptoms. Dental neuralgia very rarely, if
ever, occurs in other than persons who are of what may be called a neur-
algic diathesis ; that is to say, disease of the dental pulp alone is not
a sufficient cause of neuralgia, but in persons who, by virtue of their
nervous constitution, are subjects of neuralgic affections, or in persons
who, on account of malaria, anaemia, or other form of nervous depres-
sion or. exhaustion, have temporarily come into a neuralgic condition,
the irritation of a diseased pulp may be the exciting cause determining
an attack in the branches of tlie fifth pair of nerves, or even in more
remote parts. In making this statement the reflected pains of which I
have spoken above are excraded. They do not properly come under the
denomination of neuralgic affections, though they seem to have been
widely recognized as such by members of the profession. It is rather
to the credit of the scientific following of the symptomatology of disease,
that many of the painful maladies heretofore regarded as neuralgic have
been assigned names in accord with their true character. Still, after the
exclusion of these forms of reflected pain cases occur now and then that
undoubtedly present the characteristics of neuralgia. It seems that
irritation of terminal nerves will slowly bring about an unusual excita-
bility of the region supplied by the nerve-trunk from which the branch