Toothache is a general complaint for patients who come to a dental clinic. When a person sees a dentist or a doctor complaining about odontogenic pain, the most difficult part of the diagnosis is to assess the origin of the pain. It might be associated with a headache, joint pain, muscular. When it comes to a pulpal verdict, the correct answer would be symptomatic irreversible pulpitis. Odontogenic pain is one of the most common forms of orofacial pains. A misdiagnosis can lead to unnecessary treatment for the patient. Odontogenic pain, also commonly known as tooth pain, originates from dental. Differential diagnosis for odontogenic pain is outlined in table 1. However, dentists often come upon a patient who has chronic pain in the tooth, head and neck region. Regions often presenting as orofacial pain complaints include the sinuses, salivary gland, ears, eyes, throat, mandibular, and maxillary bone pathology. Pdf management of odontogenic and nonodontogenic oral. However, the site the patient feels pain may not be the actual source of pain. The tooth may be sensitive to pressure, heat, cold, or sweets. These non odontogenic pains may pose a diagnostic dilemma for the dental.
This paper discusses nonodontogenic sources of dental pain and the. Toothache represents the most common example of orofacial pain. The objective of this article was to present two nonodontogenic conditions that may mimic odontogenic toothache. In most cases, these odontogenic pains are managed well by dental treatments. Pain in the orofacial region is the most common reason for patients to visit a dental clinic. Oral pain of nonodontogenic origin can originate from the intraoral structures, such as buccal mucosa, gingival tissues, and alveolar bone. These non odontogenic pains may pose a diagnostic dilemma for the dental practitioner who routinely diagnoses and treats dental pain. Pain can be referred from local and distant structures, including musculoskeletal, neuropathic, and neurovascular sources.
Orange beautiful 10 operatory office ready for merger. Its origin is mostly odontogenic, but several other conditions may mimic dental pain or present themselves as such. Although patients may perceive that pain originates in a specific tooth, the pain may actually be referred from non dental structures. The term non odontogenic toothache defined the pain on tooth and adjacent structure which has not originated from pulpal and periodontal tissues. The pain is decreased with sublingual nitroglycerin. Diagnosing the non odontogenic toothache friday, april 7 2 pm 5 pm. Two cases are presented in which one is related to the upper left second premolar and the other is related to the upper left first molar. One of such entity is osteomyelitis having radiographic similarity with periapical radiolucency during its initial stage. Orofacial nonodontogenic pain ache not coming from the.
A summary estimate of nonodontogenic tooth pain frequency was derived using. Local provocation of the tooth does not alter the pain. Dental practitioners should have an understanding of the complex mechanism of odontogenic pain and the manner in which other orofacial structures may simulate dental pain. Generally toothaches have their origin in the pulpal tissues or periodont al structures. Nonopioid analgesics including paracetamol and nsaids have been demonstrated to be superior analgesics in dental pain compared to opioids at. Journal of the california dental association issn 10432256 is.
Similarly, dental pain may be referred to non dental structures. Pain is perfect misery, the worst of evils and excessive, overturns all patience john milton, paradise lost 2. Dental instruments a pocket guide to identification 2nd edition pdf. These non odontogenic pain induce a diagnostic dilemma for the. Odontogenic pain, also commonly known as tooth pain, originates from dental structures, pulpal or periodontal. This website provides free medical books this website provides over 0 free medical books and more for all students and doctors this website the best choice for. A case of orthodontic treatment with an atypical pain disorder. These cases of odontogenic pain are managed well and predictably by dental therapies. The orofacial region is the most frequent site for patients seeking medical attention for pain 1, 2 with 12. Conservative dentistry and endodontics, maulana azad institute of dental sciences, new delhi, india.
A case of orthodontic treatment with an atypical pain. This is because, often, the non odontogenic pains are mistaken with odontogenic pains. These pain presentations are the bread and butter of dental care and other surgical specialties. Hargitai, dc, usn, lieutenant commander frederick j. Orofacial nonodontogenic pain ache not coming from the tooth. This is an example of so called non odontogenic toothache. Nonodontogenic toothache is heterotopic pain that the site of pain is not in the same location of the source of pain.
Toothache odontogenic and non odontogenic pain tooth pulp periodontal priodontitis. Most toothaches have their origin in the pulpal tissues of periodontal structures. Most toothaches have their origin in the pulpal tissues or periodontal structures. Up to 22% of adults in the united states experience orofacial pain during any 6month period. There are a multitude of non odontogenic pains that can present at the site of a tooth and can mimic a toothache. Knowledge of the various nonodontogenic pains will ultimately prevent misdiagnosis and the. A deep, diffuse toothache that may sometimes pulsate. Nonodontogenic facial pain can be caused by inflammation due to tumour, infection, or trauma. Without a thorough diagnosis, or in the absence of conclusive findings, a dentist may treat the pain as odontogenic toothache. Specifically, extraoral facial pain can be the result of temporomandibular disorders, neuropathic. Description a toothache may feel like a sharp pain or a dull ache. Restoration of the endodontically treated tooth 23. Pdf nonodontogenic toothache revisited researchgate.
Combining ibuprofen with apap provides dentists with an additional therapeutic strategy for. These nonodontogenic pains may pose a diagnostic dilemma for the dental practitioner who routinely diagnoses and treats dental pain. Toothache is a common complaint in the dental office. Patients can present with pain of odontogenic or nonodontogenic origin, arising from the facial area, temporomandibular joints, ear, eyes, pharynx and larynx. Toothache of nonodontogenic pain, the trigeminal nerve. Toothache is a common complaint in the dental clinic. Less commonly, nondental conditions can cause toothache, such as maxillary sinusitis, which can cause pain in the upper back teeth, or angina pectoris, which can cause pain in the lower teeth. Pain disorder, non odontogenic toothache, tricyclic antidepressant. Management of odontogenic and nonodontogenic oral pain. Toothache odontogenic and non odontogenic pain pdf for free. Webb, dc, usn introduction patients with dental pain can often localize the area of. Toothache definition a toothache is any pain or soreness within or around a tooth, indicating inflammation and possible infection. Pdf management of odontogenic and nonodontogenic oral pain. Frequency of nonodontogenic pain after endodontic therapy.
The dilemma the clinician faces is finding the correct origin of this pain whereby an effective treatment will provide relief. Pain originating from pulp dentine complex andor periodontal structures presents with variable clinical characteristics and can be accurately diagnosed and treated. Odontogenic and nonodontogenic pain pocket dentistry. Pdf nonodontogenic tooth pain of nose and sinus origin. For those mechanistically inclined, there are two types of, healthy pains, these are nociceptive and inflammatory pain infective or post. The differential diagnosis of toothache from other. Tooth andor its supporting structures are often source of pain. Pain of odontogenic and nonodontogenic origin springerlink. Nonodontogenic toothache revisited article pdf available in open journal of stomatology 0103 january 2011 with 1,003 reads how we measure reads. Odontogenic pain, a common malady globally and the most prevalent type of orofacial pain, originates from dental structures, pulpal or periodontal.
The differential diagnosis and management of the non odontogenic toothache jeffrey p. Teeth are a common and obvious source of orofacial pain. Pain is not a simple sensation but rather a complex neurobehavioral event involving at least two components. Pain of odontogenic and nonodontogenic origin pocket. The orofacial pain is the most frequent site for a patient seeking medical consult for pain with 12. Nonodontogenic toothache revisited semantic scholar. Persistent idiopathic facial pain pifp, previously known as atypical facial pain, is a persistent facial pain that does not have the classical characteristics of cranial neuralgias and for which there is no obvious cause. Decker inc non odontogenic toothache and chronic head and neck pains.
In addition, presence of sensitivity, pain on percussion, pain during mastication is other key features. Although pain of dental origin is the most common orofacial pain, other non odontogenic pains can affect the orofacial region and occasionally mimic dental pain. Zeroing in on the cause of your patients facial pain. Pain in the orofacial region is by far the commonest reason for patients to seek treatment. Non odontogenic toothache and chronic head and neck pains.
Knowledge of the various non odontogenic pains will ultimately prevent misdiagnosis and the delivery of incorrect and sometimes. Non odontogenic toothaches could be emanated from myofascial, neurovascular, neuropathic or paranasal sinus pns problems. On the other hand, nonodontogenic pain may be described as tingling, shooting, burning, nonlocalized, which crosses the midline. Although pain of dental origin is the most common orofacial pain, other nonodontogenic pains can affect the orofacial region and occasionally mimic dental pain. A non odontogenic toothache of neuropathic origin jyoti ahlawat 1, amit malhotra 1, abhimanyu sharma 2, sangeeta talwar 3 1senior resident, m. The differential diagnosis of toothache from other orofacial pains in clinical practice j linn, i trantor, n teo, r thanigaivel, an goss background. Nonodontogenic toothache definition of nonodontogenic. Diagnosis, causes, prevention and treatment paul a. General characteristics of a nonodontogenic toothachesummary 1.
There is a risk that endodontic treatment may be initiated in patients that do. There are many descriptions of the pain caused by migraine, and it is most often described as pounding and pulsating pain. Toothache of nonodontogenic origin is not true dental pathology, rather it is the pain referred into the dentition from distant location. Combining the present studys finding with our previous study that estimated the. Often they may be complaining of pain from their teeth.
The toothache has a temporal behavior that increases with physical exertion or exercise. Hargreaves, dds, phd department of endodontics university of texas health science center san antonio, tx. Non odontogenic toothache, tricyclic antidepressant. All etiologies must be evaluated on an individual basis, bearing in mind that occasionally more than one cause can contribute to the symptoms.
Toothache odontogenic and non odontogenic pain pdf. Nonodontogenic oral pain can originate from intraoral structures such as gingiva and buccal mucosa. Tooth and intraoral structures are often the main sources of orofacial pain. Nonodontogenic tooth pain characteristics are the key to identifying the underlying disorder. Nonodontogenic toothache is a less common finding than odontogenic tooth ache. The per radicular and pulp of the tooth are the most common culprit when it comes to tooth pain. Pulpal pain, periodontal pain, gingival pain and bone pain are the 4 different types. However, clinician often encounters situation when odontogenic causes. Local anesthetic blocking of the offending tooth does not eliminate the pain. Odontogenic pain is unilateral, localized and relieved by local anesthesia 6.
This differs from primary pain, in which the site of pain is the actual site which the pain originates. Common nonodontogenic causes of orofacial pain can be mostly managed in primary care, but important diagnoses such as acute coronary syndrome. Most patients reporting dental pain have symptoms that are odontogenic. In cases of severe pain, identifying the problem tooth is often difficult. This is a pdf file of an unedited manuscript that has. Download cohens pathways of the pulp 11th edition pdf. This article provides a simple overview of acute trigeminal pain for the non dentist. This article focuses on the emergency assessment, triage and non specialist management of oral pain and odontogenic.
Knowledge of the various non odontogenic pains will ultimately prevent misdiagnosis and the. Diagnostic challenges of nonodontogenic toothache the objective of this article was to present two nonodontogenic conditions that may mimic odontogenic toothache. Toothache of nonodontogenic origin is not true dental pathology, rather it is pain referred into the dentition from a distant location. Of particular interest for is that dental pain can mimic both trigeminal. Diagnosis of enigmatic nonodontogenic bony pathologydo.
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