Referred pain: a confusing case of differential diagnosis between two teeth presenting with endo-perio problems.
OBJECTIVE
A case of a patient with a confusing referred pain is reported that emphasizes the importance of providing a differential diagnosis in order to avoid inappropriate treatment.


CONCLUSIONS
This article describes the management of a patient presenting with a combined endo-perio problem that was apparently treated adequately. After a short period of time, the reappearance of mild pain was misdiagnosed. The situation was more complicated when multiple diagnostic procedures were attempted and inadequate therapies were tried consecutively. When the true differential diagnosis was established and appropriate treatment provided, the symptoms disappeared and normal function returned. Diagnosis of teeth with necrotic pulps may be difficult to establish with possible reasons including inconclusive and poorly localized symptoms and signs. The situation can be further complicated if other teeth developing endodontic or combined endo-perio problems occur simultaneously as this may lead to misdiagnosis and treatment of the wrong tooth.
Koyess
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Department of Endodontics, Dental School at the Lebanese University, Beirut, Lebanon. bestendo@msn.com
Fares
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M
D000328:Adult; D003790:Dental Pulp Necrosis / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D006801:Humans; D008963:Molar; D008964:Molar, Third / Q000601:surgery; D010485:Periapical Periodontitis / Q000150:complications / Q000175:diagnosis*; D011671:Pulpitis / Q000175:diagnosis; D011859:Radiography; D012390:Root Canal Therapy; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000150:complications / Q000000981:diagnostic imaging; D014098:Toothache / Q000209:etiology*