Toothaches have various etiologies or "faces." Therefore, as an oral medicine specialist, I am frequently called upon to consult on patients whose patterns of toothache do not fit the mold.
When a toothache strikes, most people automatically assume that it’s the direct result of a structural defect affecting the tooth. Most toothache occurs secondary to cavities, gum disease, abscessed teeth, heavy biting forces, or cracked teeth. However, it is important to note that there are many other reasons for pain involving the teeth.
1. The head is a complex unit with multiple closely associated anatomical structures supplied by a specialized and intricate nervous system. Pain can refer from its origin or source in the head to a neighboring or distant structure.
This phenomenon of referred pain can be a source of confusion to patients and clinicians. It can lead to inappropriate and unnecessarily invasive treatments targeted to the site of referred pain instead of its origin.
2. Dysfunction, disease, or injury affecting the nervous system can lead to pain that mimics toothache in the absence of any dental problem such as a cavity, fractured tooth, or periodontal (gum) disease.
As clinicians, it is crucial to identify toothaches that are not of dental origin and proceed with caution when managing these cases.
Dental treatment such as restorations (fillings), root canals, and extractions will not eliminate the pain from these disorders.
Some disorders that may present with symptoms that could mimic toothache in some patients include:
• Trigeminal neuralgia
• Trigeminal neuropathic pain
• Referred muscular pain
• Sinusitis
• Headaches: Migraine headaches, cluster headaches, and other trigeminal autonomic cephalalgias
• Brain tumors
Next time, I’ll talk about how we evaluate patients with suspected non-dental toothaches.
See you soon!
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