Dentaltown March 2020 - 50

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What's the Diagnosis When a Patient
Drinks Ice Water to Relieve Pain?
A rare issue in one Townie's office leads to a good refresher course on treating a "hot tooth"

palmers31
Member Since: 07/30/08
Post: 1 of 81

I can never remember what the diagnosis is for this. You know these patients-in otherworldly pain and the only thing that provides relief is drinking ice water. They usually present
to the office with a gallon of it, sipping every few seconds. What is the pulpal diagnosis? ■
8/18/2019

Dented DDS
Member Since: 08/17/16
Post: 2 of 81

palmers31
Member Since: 07/30/08
Post: 3 of 81

Irreversible pulpitis. ■

8/18/2019

No, that's not it! I know that, of course! I'm almost certain there's another term for this
specific type of acute pulpal response. ■
8/18/2019

davidpalmer
Member Since: 04/14/00
Post: 4 of 81

Hot tooth! Tremendous pressure being built up in the alveolus by anaerobic bacteria producing a gas with no exit "pressure valve." The absolute peak of tooth pain. Yes, the pulp will be full
of foul-smelling pus under pressure. The ice-cold water makes the gas contract slightly to help
relieve the pressure. As soon as it warms up, the intense pressure pain resumes. I've had to start
giving local, stop halfway through to let the patient swish with ice water, then continue. Patients
cannot think clearly till you get them numb. ■
8/18/2019

Josh018
Member Since: 04/03/14
Post: 7 of 81

Pulpal necrosis/acute apical abscess. There are only certain pulpal and apical diagnoses.
People will use other terms to describe clinical presentations but those many times are not an
actual diagnosis. ■

8/18/2019

almunk
Member Since: 12/17/05
Post: 10 and 13 of 81

I was taught in dental school that it was gas expansion and contraction in these cases. About
10 years ago on DT, I was told this is not correct, that instead it is some sort of fibers in the pulp
that somehow maintain vitality despite all other signs of necrosis. Maybe some endo scholar can
explain this again to me.
I looked it up on DT, and I found this quote from over 10 years ago:
"C" delta fibers often live beyond the death of the "A" fibers in the pulp. They sense heat and they
throb. "A" deltas are cold, sharp pain fibers. They die earlier.
Evidently, when the "A" fibers die, we have what is commonly called a necrotic pulp-periapical
lucency, swelling, etc. But the "C" fibers live on, and are heat-sensitive, thus the ice water scenario. ■

8/19/2019

Endo1234567
Member Since: 07/26/10
Post: 15 of 81

Official diagnosis would probably be symptomatic irreversible pulpitis. It's when the pulp is
still partially vital, extreme heat sensitivity that is relieved with cold. If the pulp was necrotic,
the patient wouldn't feel the pain to heat. ■
8/19/2019

50

MARCH 2020 // dentaltown.com

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2/18/20 2:23 PM


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Dentaltown March 2020

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