Dental odontogenic pain t ara renton, p rofessor in oral s urger y, bds mdsc phd fds r cs fracds oms il tm king s college london dental i nstitute, denmark hill campus, bessemer road. Local provocation of the tooth does not alter the pain. Nonodontogenic pain is not an uncommon outcome following root canal therapy. History onset and duration the onset and timing of dental pain often suggests the diagnosis. Management of odontogenic and nonodontogenic oral pain.
A toothache, or a violent passion, is not necessarily diminished by our knowledge of its causes. The differential diagnosis of toothache pain starts with a thorough history, clinical and radiographic exams, and a battery of tests. Orofacial pain can be divided into odontogenic and nonodontogenic pain. Odontogenic infection an overview sciencedirect topics. The dilemma the clinician faces is finding the correct origin of this pain whereby an effective treatment will provide relief. An effective strategy for pain management is the 3d approach. Combining ibuprofen with apap provides dentists with an additional therapeutic. Odontogenic pain management fdi world dental federation. The assumption that a patient enjoys good dental health may not always be true. Odontogenic pain, pulpotec, root canal dressing corresponding author. It affects millions of people every day around the world, and can be caused by a variety of disorders and diseases. Guide to infection prevention in orthopedic and pain. The aim of this case is to illustrate that the clinician should consider that an apparent benign dentigerous cyst can suffer malignant transformation and that all material removed from a patient must be evaluated histologically.
Psychosomatic pain the british journal of psychiatry. The patient may present to the clinician in existing pain, which may often. Neuroplasticity, central sensitization and odontogenic. Managing the periodontal inflammation is of primary importance in cases of combined occlusal. Non odontogenic toothache and chronic head and neck pains. Therefore, pain management in endodontic treatment is an important clinical consideration. Decker inc non odontogenic toothache and chronic head and neck pains. Pain of odontogenic and nonodontogenic origin pocket. Psychosomatic pain volume 188 issue 1 stephen tyrer. The pain is decreased with sublingual nitroglycerin. Building effective strategies for the management of endodontic pain. Recent findings the majority of odontogenic disease is caused by periodontitis and iatrogenesis. Odontogenic pain goranka prpicmehicic, nada galic department of endodontics and restorative dentistry, school of dental medicine, university of zagreb, croatia summary pain has the function of a warning to tissue damage and activation of defensive mechanisms, with the aim of prevention of further damage.
Benign tumors of the jaws simpo pdf merge and split. Although odontogenic dental pain is the most commonly reported form of orofacial pain when presenting to the dentist, it should be recognised that this symptom could be caused by. This case showed that the signs and symptoms of a herpes zoster infection in the mandibular branch can be misdiagnosed. Pain management in endodontic treatment decisions in. Oral medicine and medically complex patients, sixth edition. Department of endodontics and restorative dentistry, school of dental medicine. Of particular interest for is that dental pain can mimic both trigeminal neuralgia and other chronic trigeminal pain disorders. Bestoon mohammed faraj, department of conservative dentistry, school of dentistry, university of sulaimani, sulaimani, iraq, email.
Diagnosis, causes, prevention and treatment paul a. Diagnosis of orofacial pain of dental origin springerlink. Pdf this article provides a simple overview of acute trigeminal pain for the non dentist. Odontalgia toothache is the most common source of odontogenic pain. Pdf management of odontogenic and nonodontogenic oral.
Inadequate knowledge of the etiopathology of pain and the neurobiological mechanisms underlying persistent pain can lead to inaccurate diagnoses and subsequent ineffective or. In addition to producing pain and discomfort, odontogenic infections can extend beyond natural barriers and result in potentially lifethreatening complications, such as infections of the deep fascial spaces of the head and neck. Odontogenic tooth related pain is by far the most prevalent source of orofacial pain. Hospital charting 441 examples of hospital charts table a191 441. Pain in the orofacial region is by far the commonest reason for patients to seek treatment. During the prodromal stage, the presenting symptoms may include odontalgia, which may prove to be a diagnostic. Facial pain of odontogenic origin must not be overlooked as a possible source of chronic or complex orofacial pain. Pain referred from the sternocleidomastoid muscle to the temporomandibular joint is an example of referred pain 4.
When dealing with odontogenic pain, dentists should base their clinical and pharmacological decisions on a methodical, ethical and objective evaluation with the strongest evidence. The painful tooth mechanisms, presentation and differential. Ulrich klein dmd, dds ms, in bermans pediatric decision making fifth edition, 2011. Problem solving in the diagnosis of odontogenic pain. Pain that has previously been present then recurs suggests dental abscess formation caused by a nonvital tooth. Regions often presenting as orofacial pain complaints include the sinuses, salivary gland, ears, eyes, throat, mandibular, and maxillary bone pathology. Pain arising from the teeth and supporting structures must a lways be considered during any examination of a facial pain. Primary intraosseous carcinoma of the jaws pioscc might arise from odontogenic epithelium, more commonly from a previous odontogenic cyst. Among these differential diagnoses are trigeminal neuralgia, central nervous system lesions, odontogenic pain, sinus pain, otological pain. Often they may be complaining of pain from their teeth. Clinical diagnosis of herpes zoster presenting as odontogenic pain 455 of postherpetic neuralgia.
Orofacial pain can be defined as any pain that occurs in the face and mouth, including the nose, ear, eye and throat. Polish pain society asked polish national health fund to provide data concerning diagnosis of neuropathic pain syndromes among outpatients on the basis of icd10 between 1 june 2008 31 may 2009. Nonodontogenic oral pain can originate from intraoral structures such as gingiva and buccal mucosa. Odontogenic medical definition merriamwebster medical. This issue of colleagues for excellence is based upon those studies and describes a simple and effective strategy for managing acute dental pain.
Pain of odontogenic and nonodontogenic origin springerlink. Colleagues excellence american association of endodontists. Combining the present studys finding with our previous study that estimated the. There were 18 lesions in the posterior mandible, 3 in the anterior mandible and 6 in the posterior maxilla fig. Further testing in such a case often indicates that the teeth in the area of felt pain are normal, whereas the opposing carious tooth is the source of the referred pain. The timely diagnosis and management of dental pain is an essential component of dental care, and this article reminds readers of the common presenting symptoms of simple dental pain, diagnoses and pragmatic management. Common nonodontogenic causes of orofacial pain can be mostly managed in primary care, but important diagnoses such as acute coronary syndrome. T he need to perform endodontic treatment is likely due to a patient presenting with inflamed andor infected pulpal tissue. All dentists should be comfortable with prompt diagnosis and management of these types of infections. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic. Osteosarcomas of the mandible or maxilla, also referred to as gnathic osteosarcomas, are considered distinct from conventional osteosarcomas owing to an older age of onset, a decreased tendency to metastasize, more advanced.
The orofacial pain is the most frequent site for a patient seeking medical consult for pain with 12. Occasionally in a case of spontaneous pain, gross caries may be observed in a tooth, almost invariably a molar, in the opposing arch from where the pain has been felt. Odontogenic pain is unilateral, localized and relieved by local anesthesia 6. How to combine files into a pdf adobe acrobat dc tutorials. They are mixed aerobicanaerobic with 60% caused by anaerobic and aerobic bacteria, 35% by aerobic bacteria, and 5% by anaerobic bacteria only. Pdf management of odontogenic and nonodontogenic oral pain. 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. Dental infections, including gingivitis, periodontitis, dental caries and odontogenic infections, result in numerous dental visits each year in canada. Keratocystic odontogenic tumour of lesions treated in our clinic.
Non odontogenic facial pain can be caused by inflammation due to tumour, infection, or trauma. They can range in severity from a mild buccal space infection to a severe lifethreatening multispace infection. The dental team spend most of their working lives managing patients and acute pain. This pretreatment histologic pulp status can have a direct correlation to a patients odontogenic pain symptoms.
Orofacial pain is defined as a term referring to oral pain, dental pain and pain in the face above the neck, anterior to the ears and below the orbitomeatal line. On the other hand, nonodontogenic pain may be described as tingling, shooting, burning, nonlocalized, which crosses the midline. This is a pdf file of an unedited manuscript that has. Malignant transformation of an odontogenic cyst in a. Thus, effective pain diagnosis and treatment are major chal lenges that. Common nonodontogenic causes of orofacial pain can be mostly managed in. Non odontogenic toothache is the type of heterotopic pain. Orofacial pain odontogenic pain pain coming from the. Odontogenic pain may arise from the suspected tooth, or the pain may be. Odontogenic infections are generally polymicrobial and from endogenous oral flora. Adenomatoid odontogenic tumors comprise 3% of all oral tumors. Relate the three types of nerve fibers found in pulp and how their responses are critical in diagnosing pain 4.
Because of the high prevalence, it is important to rule out odontogenic pain when evaluating patients with orofacial pain complaints. Treatment consisted of enucleation and curettage for 22 of the lesions, resection. Odontogenic pain, also commonly known as tooth pain, originates from dental structures, pulpal or periodontal. Odontogenic pain, also known as dental pain or tooth pain, is a common condition worldwide and the most prevalent form of orofacial pain. Ramandeep singh gambhir reader and head, gian sagar dental college and hospital, rajpura, punjab, india tel.
Frequency of nonodontogenic pain after endodontic therapy. The toothache has a temporal behavior that increases with physical exertion or exercise. Fluid management 432 fluid deficits table a151 432 types of intravenous fluid milliequivalentsl table a152 433 16. For the majority of patients, the pain is of odontogenic origin, as a consequence of dental disease. These two cases highlight the complexities involved in diagnosing nonodontogenic toothache. Patients can present with pain of odontogenic or non odontogenic origin, arising from the facial area, temporomandibular joints, ear, eyes, pharynx and larynx. 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. Four years of clinical experience with the efficacy of. The remainder of this article will focus on nonodontogenic pains of. Osteosarcoma is the most common primary sarcoma involving the jawbones, although such localization accounts for fewer than 5% of all osteosarcomas affecting the skeleton. Topographical classification is often applied to this complex region. These non odontogenic pains may pose a diagnostic dilemma for the dental practitioner who routinely diagnoses and treats dental pain. Therefore, orofacial pain may sometime pose a diagnostic dilemma for the oral physicians and clinicians.
Choose from a variety of file types multiple pdf files, microsoft word documents, microsoft excel spreadsheets, microsoft powerpoint. When dealing with odontogenic pain, dentists should base their clinical and pharmacological decisions on a methodical, ethical and objective evaluation with the strongest evidence available, and not on personal clinical experiences or anecdotal knowledge. Data provided by nhf revealed, that in 20082009 different neuropathic pain syndromes were diagnosed and treated in 111 041 patients 0,3% of. Tooth and intraoral structures are often the main sources of orofacial pain. Cysts are radiolucent lesions, and the prevalent clinical features are swelling, lack of pain unless the cyst becomes secondarily infected or is related to a nonvital tooth, and missing teeth, especially third molars. Odontogenic pain refers to pain initiating from the teeth or their supporting structures, the mucosa, gingivae, maxilla, mandible or periodontal membrane. At least one confirming, reproducible test that corroborates radiographic or clinical evidence of pathology is necessary to make a diagnosis of odontogenic etiology. Dental instruments a pocket guide to identification 2nd edition pdf. In addition, presence of sensitivity, pain on percussion, pain during mastication is other key features. Tooth andor its supporting structures are often source of pain. These non odontogenic pains may pose a diagnostic dilemma for the dental practitioner who.
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