| 1. Objective: Acute papillary gingivitis is one of the most frequent disease in periodontal department. But the rate of misdiagnosis of the disease is high. This will bring unnecessary loss to both the patients and the dentists. The aim of this research project was to investigate the differential diagnosis of acute papillary gingivitis , in order to increase the correct diagnosis rate of it. 2. Patients and Methods: 52 patients were involved in this research who were diagnosed acute papillary gingivitis in periodontal department of Ji-Lin University Stomatology Hospital from June 2003 to the end of March 2005. This is a classical example of case with acute papillary gingivitis was diagnosed acute pulpitis: General Situation : A thirty-one years old male came to a local clinic complaining of spontaneous pain and nyctalgia at left mandibular second premolar for three days on November tenth, 2004. The first diagnosis was "acute pulpitis", the patient was given "root canal therapy". The treatment has been completed seven days before, but the pain was still there. The man went to our department to seek for help on December eleventh, 2004. Chief Complain: spontaneous pain for about one month. Medical Record:Seek for help to a local clinic about spontaneous pain and nyctalgia at left mandibular second premolar for three days one month ago,he can be found "deep caries at distoclusal surface,exploring pain(+),sensitivity to temperature test, sensitivity to percuss",and the diagnosis was "acute pulpitis",he received "root canal therapy". The treatment was completed a week ago,but the pain of left mandibular second premolar was still there. Medical History :A medical history indicated that the patient was in excellent health. Oral Examination: There's a silver amalgam filling at the distoclusal surface of his left mandibular second premolar, and no prematurity. Sensitivity to temperature test, light pain to percuss, about 1°loose. A larger silver amalgam filling at the occlusal surface of left mandibular first molar,there's a trivial secondary caries. The papilla gingival between them is congestive and dropsical, food debris and tartar can be found,bleed and pain to probe. Dentalfloss can easily get across the contact area . Diagnosis:left mandibular second premolar distal papillary gingivitis Treatment: Conventionality disinfect by 2% iodine tampon,subgingival scaling,remove subgingival tartar,dental plaque,materia alba ,food debris,inflammatory soft tissue and osseous tissue,3%H2O2 rinse, spread astringent, advise not to use the suffering tooth. After one week the patient said the pain is catabatic, temperature test(-), percuss(-). The gingival is pink,shape is natural,oral cleanness is perfect . Full crown is advised to rebuilt a perfect contact area ,prevent to recrudescence of food impaction and papillary gingivitis. 3. Discussion: 3.1 Cause of misdiagnosis:The patient's chief complain is"spontaneous pain at left mandibular second premolar for three days"when he first visit to a dentist, oral examination can found"deep caries at distoclusal surface",so the dentist extrapolate it's an acute pulpitis that deep caries caused. And "exploring pain(+),sensitivity to temperature test,sensitivity to percuss"all of these supported the diagnosis of acute pulpitis, then give the tooth a "root canal therapy", this is a routine thought. Pain during the treament was thought to be caused by root canal preparation and dressing,these are hackneyed also. Pain after root canal therapy and silver amalgam filling was thought caused by stimulater of root canal filling and cataplasm., due to the X-ray showed the root canal filling is satisfied, these things are not rare in patients who have been given root canal therapy,it didn't cause enough recognition. 3.2Differentiate and diagnose: This is the essential to differentiate acute pulpitis and acute papillarygingivitis: table2 the essential to differentiate AP and APG...
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