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Non-Dental Toothaches: Identifying Red Flags

Updated: Feb 12

This post is the second one I am publishing on the topic of non-dental/non-odontogenic toothaches. In my first post, I briefly introduced the concept of non-dental toothaches, and highlighted different disorders that can present with symptoms that can mimic a regular toothache. I recommend reading the first post HERE before continuing with this one.

Neuropathic Pain Descriptors

The way a patient describes their pain helps reveal the etiology and diagnosis of the pain.

Patients with neuropathic pain or nerve pain such as trigeminal neuralgia are more likely to use words such as electric shock, tingling, burning, pins and needles, numb, and itchy to describe their facial pain or toothache.

These words are typically not associated with a regular toothache or even temporomandibular disorders (TMDs).

Therefore, when a patient points to a tooth as the site of pain but describes it as an electric shock, it indicates that the pain may not be due to a dental problem such as a cavity or periodontal (gum) disease.

Some other tell-tale signs of non-dental toothaches described by patients include:

Other Red-flags of Non-dental Toothaches

1. History of persistent pain despite multiple dental procedures to stop the pain

2. Pain that migrates from one tooth to another and even crosses the midline

3. Episodic, recurrent, intense pain, lasting a few seconds to two minutes, triggered by non-painful stimuli such as light touch

4. Associated throbbing, migrainous headaches, worse with lights, sounds, and physical activity, with or without visual and sensory changes (aura)

5. Associated autonomic symptoms on the affected side. That is, red eyes, tearing, puffy eyes, stuffed-up nostrils, facial sweating

6. Associated facial numbness or weakness

7. Maxillary posterior toothache, worse with lowering the head in a patient with a history of sinusitis

As oral health care providers, we should proceed with caution in these situations. If the symptoms don’t add up, don’t force it.

Stop, re-evaluate, and consider referring to an oral medicine, orofacial pain specialist, or neurologist.

Next time, I’ll talk about the physical examination of patients with suspected non-dental toothaches.

See you soon!


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