The differential diagnosis of toothache from other orofacial pains in clinical practice

Abstract

Background: Teeth are a common and obvious source of orofacial pain. There is a risk that endodontic treatment may be initiated in patients that do not have pulp or periapical pathosis. Methods: A retrospective survey of a sample of patients referred for endodontic treatment was analysed to determine the accuracy of the diagnosis and to identify non‐dental cases. A separate prospective study of complex non‐dental orofacial pain cases was performed to determine which cases had previously received dental treatment. Results: Seventy‐seven (88 per cent) of 88 patients referred for endodontic treatment had been correctly diagnosed with solely endodontic problems. Eight (9 per cent) had endodontic plus other orofacial pain problems and three (3 per cent) had no endodontic problems but other orofacial pain problems. Forty‐four (44 per cent) of 100 non‐dental orofacial pain patients had previously received either extractions or endodontics. Conclusion: Dentists need to carefully evaluate all toothache patients to ensure that the diagnosis is correct prior to the initiation of irreversible treatment.

Neuralgia induzida por cavitação osteonecrótica

“…It affects especially females, with mean age of 40 years, but may also occur during adolescence. Pain may be located in a small area of the face or extend to associated areas, such as temporal and cervical regions 27,28,32 . Pain is described as deep, diffuse, continuous and persistent and may present sensation of burning or pressure.…”

“…Neuromodulators significantly improve pain in the beginning, and there may be pain latency periods. There are cases where pain returns without apparent reasons [25][26][27][28][29][32][33][34][35] . Glossopharyngeal neuralgia is similar to trigeminal neuralgia being differentiated by the anatomic site.…”

“…Studies 3,19 have proposed the following diagnostic criteria: pain in the alveolar bone in regions innervated by the trigeminal nerve and temporary pain relief when the region is submitted to anesthetic block. NICO also interferes with quality of life and may be easily mistaken for other neuropathic and / or deep somatic musculoskeletal and visceral diseases 4,8,9,[25][26][27][28][29] .…”

Orofacial neuropathic pain

“…Anticonvulsants significantly improve pain and there might be latency periods. There are cases when pain returns without apparent reasons [10][11][12][13][14][15][16][17] . Pain episodes cause extreme jaw restriction, including daily functions such as swallowing, speaking and teeth-brushing; sensory abnormalities are also frequent in these patients 18 .…”

Relieving idiopathic dental pain without drugs

“…However, patients with non-dental causes of orofacial pain also seeking a dental solution to symptoms which may closely mimic toothache. 1 According to Linn et al, 1 22% population experience orofacial pain, 12.2% dental pain in 6 months period. Ram et al, 2 revealed that approximately 45% orofacial pain patients went to dentist and Wirz et al, 3 reported in their study that 17% of orofacial pain was atypical odontalgia or atypical tooth pain, Other terms for this pain were neuropathic tooth pain or phantom pain.…”