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Tooth Aches of Non Dental Origin

Referred Muscle Pain

Myofascial pain involves dull, aching muscles in localized areas of the body. What may feel like a toothache can actually be myofascial pain in the jaw that has referred to the teeth. This type of pain can increase with overuse of the muscles, so treatment can involve reducing the factors that place strain on the jaw muscles.

Trigeminal Neuralgia

The trigeminal nerve provides sensation to the face and teeth, and when it is affected by trigeminal neuralgia, a patient can experience a shock-like pain, even with minimal stimulation, such as the brushing of teeth. This condition can be difficult to diagnose, particularly in its first stages, because of the variability of the pain. A neurological evaluation and brain imaging may be needed to accurately diagnose TN. In many cases, anticonvulsant medications are used to treat TN. When medication is not effective, or produces side effects, microsurgery may be needed.

Neuropathic Facial Pain

Neuropathic facial pain occurs when there has been damage to the nerves that transmit sensation in the face, teeth or gums. This can happen due to an injury, or because of tooth extraction, surgery and even routine dental procedures. Symptoms can include pain, numbness, tingling and hypersensitivity that continue even after the injury has healed. Nerve testing and local anesthetic nerve blocks are typically used to diagnose neuropathic pain. Once it is diagnosed, multiple medications are often prescribed to relieve symptoms.

Referral Headache Pain

In certain cases, headaches can be felt in the teeth, due to referral patterns of the trigeminal nerve from the nerves and blood vessels in the head. Pain can vary in severity, and is typically spontaneous with periods of remission. Treatment plans focus on the cause of the headache, and can include behavioral therapy and medications.

Cardiac Toothache

Certain heart conditions, such as acute myocardial infarction or angina pectoris, can refer pain to other areas in the body, including the jaw and teeth. This pain may or may not be associated with chest pain. The pain associated with toothaches from a cardiac origin typically increases with exercise, and decreases with heart medication. Treatment is directed at the underlying heart problem, after the tooth has been evaluated.

Sinus/Nasal Toothache

Pain in the upper teeth can sometimes be referred to by problems in the maxillary sinuses and/or paranasal mucosa. It can sometimes be associated with pressure below the eyes, and is usually felt in several teeth as a dull, aching or throbbing sensation. This pain tends to increase with the lowering of the head, when pressure is placed on the sinuses, coughing or sneezing. A diagnosis involves first evaluating a patient’s history of upper respiratory infections, nasal congestion and sinus problems. Diagnostic tests can include visual nasal exams, sinus X-rays, and MRI. Treatment plans typically involve antihistamines, decongestants and antibiotics.

Neoplasias and Other Lesions in the Head

Tumors, aneurisms and other intracranial disorders can cause pain in the mouth or teeth. Tumors sometimes also appear near the nerves of the teeth, which can cause the teeth to become loose or displaced. Symptoms associated with this type of tooth pain can include weight loss and fatigue. These problems are rare, and are detected through image tests of the face, jaw and head.

Salivary Gland Dysfunction

Patients with salivary gland dysfunction can experience a toothache for several different reasons. It may be related to the absence of saliva, which can compromise the health of the teeth and supporting structures. The pain may also be referred from the salivary glands too the teeth. A comprehensive evaluation of the salivary glands can determine which reason is causing the pain.

Psychological Disturbances

Psychological disturbance are considered contributing factors of tooth pain, not the cause. Factors such as stress, muscle tension, anxiety and depression can all contribute to the experience of tooth pain.

Getting Help/What to Expect at the Doctor’s Office

A patient should first seek the experience of a dentist who specializes in orofacial pain, such as the dentists at Southwest Pain Management, to receive an accurate evaluation of a toothache. The dentist will perform a thorough examination, including X-rays and an evaluation of the patient’s clinical history. If the cause of the pain does not appear to be dental related, treatments such as root canals and extractions should not be performed. If there is no apparent dental cause for the pain following testing, identifying the non-dental source of the pain is the next step. There are certain symptoms that indicate that the cause for pain is not related to the teeth including:
• Pain existing in several teeth
• Pain moving from one tooth to another
• Pain that tingles or burns
• Pain that occurs intermittently or without provocation
• Pain that does not disappear when the dental structures are anesthetized

An evaluation of non-dental related toothaches will involve a thorough assessment of a patient’s clinical history, and previous treatments. The physician will also need to know details of the pain, such as intensity, whether it is spontaneous or continuous, and alleviating factors.

A physical examination will then be performed, including an evaluation of the appearance of the painful area, pain when pressing on one area vs. another area, etc. Tests may include an ice and heat test or the use pins and brushes. Nerve blocks may also be performed, and involve the numbing of areas of the mouth or head with local anesthetic injections. MRI or CT scans may also be used to determine whether a more serious condition is present.

The search for a correct diagnosis for toothaches of a non-dental origin can be frustrating. However, new diagnostic tests and treatment options are constantly being developed. Close communication with a qualified orofacial pain dentist is crucial for the outcome of each patient.

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