It should be noted that the vast majority (80%) of patients presenting with dentofacial pain are suffering from simple dental pain (such as Neuropathic and Neurogenic Pain) due to a problem with the teeth. For the remaining 20%, however, we have to look further for a cause of the pain.
This can take time and tests as the normal causes are excluded and we work are way down a list of next “most likely” explanations. This time, can run over several appointments and often a referral to a specialist team in a dental hospital is required to finally track down the cause. For the individual at the suffering end of the pain, this time, can be frustrating, disheartening and can cause real anxiety. It is important for both the dentist and the patient to remember that they both want the same thing- to find a cause for the pain (such as Neuropathic and Neurogenic Pain) and to then relieve it – but neither wants to provide the wrong treatment which could waste even more time and money and potentially make matters worse.
Referred pain is where the site and the source of the pain are not the same. A very common cause of referred pain is TMD where tight muscular spasms in the chewing muscles can be felt as pain in the molar teeth and it is not uncommon to see patients who have received multiple treatments to a row of molar teeth trying to track down the cause of this mysterious toothache that never gets better with treatment. the pain continues even after treatment. In this case, it is the muscular pain of TMD that needs treating not the teeth that appear to be hurting.
Another far more serious but, fortunately, a much rarer example of referred pain to the lower jaw (typically the left side but can be on the right as well) is referred cardiac pain from someone suffering from angina or even a myocardial infarction (MI). This pain is often worse on exercise and clearly these patients need urgent medical attention.
Neuropathic and neurogenic pains are pains that reflect damage to the nerves themselves or are a product of faulty messages being sent by nerves that the brain then interprets as pain. Common examples are trigeminal neuralgia, atypical facial pain, burning mouth syndrome, post herpetic neuralgia and so on. The signs and symptoms of these conditions can vary widely from one individual to the next and can develop over months or years. Two features common to all neuropathic/neurogenic pains, however, are the fact that they do not respond to normal anti-inflammatory painkillers such as ibuprofen or paracetamol and they seldom if ever wake patients in the night.
These pains can be horribly debilitating for sufferers and are often diagnosed after lengthy periods of misdiagnosis of mistreatment. It is important for all dentists (and doctors) to remember that patients do not make these symptoms up, they are suffering and we need to acknowledge when we are not able to find a cause then we need to seek the advice and help of specialist teams who can help. A meticulous study of the patients signs and symptoms along with sensible tests and radiographs should be enough to tell us which cases we can help and which we cannot.
If you would like more information about Neurogenic Pain or to make an appointment please contact our Reception Team on 01580 752202 or firstname.lastname@example.org who will be more than happy to help with any matter.