Dental Health Library Article
Tooth Pain Causes
Anatomy of Pain
Causes of Non Dental Tooth Ache Pain
Referred Muscle Pain
Muscle or myofascial pain is a condition characterized by dull, aching muscles with localized tender areas. These tender areas can refer pain to other structures in consistent patterns. Jaw muscles can refer pain to the teeth, and this can be perceived as dental or intraoral pain.
The pain can increase with overuse of the muscles. If this is the case, treatment often involves treating the jaw muscles and reducing the factors that place strain on them.
The trigeminal nerve provides sensation to the face and teeth. Trigeminal neuralgia is a condition affecting the trigeminal nerve and is characterized by episodes of short, severe, shock-like pain, after harmless stimulation of the area such as brushing of the teeth, mimicking a toothache.
When this condition appears in its first stages (pre-trigeminal neuralgia), it can be difficult to diagnose due to the variability of the pain. Proper diagnosis may include a neurological evaluation and brain imaging. Education, anticonvulsant medications and sometimes microsurgery are used to treat this condition.
Neuropathic pain is a group of conditions in which there has been damage to the nerves that transmit sensation. Traditionally, neuropathic facial pain begins following an injury to the face, teeth or gums. This can be through tooth extraction, trauma, surgery, or sometimes routine dental procedures. The result is pain and other symptoms (numbness, tingling, hypersensitivity) that persist even after the injury has healed.
Specific nerve testing or local anesthetic nerve blocks are useful to diagnose neuropathic pain. Education and multiple medication regimens are used to treat neuropathic pain.
Referral Headache Pain
Migraines, cluster headaches and hemicrania are types of headaches that result from changes in the nerves and blood vessels of the head. In some cases, through referral patterns of the trigeminal nerve, these headaches can also be felt in the teeth, causing toothaches.
The pain can be spontaneous, severe, throbbing, and have periods of remission. Treatment is directed at the cause of the headache and often includes behavioral therapy and medications.
Heart problems such as angina pectoris or acute myocardial infarction, refer pain to the shoulder, arm and even to the jaw. We know that these conditions can refer pain to your teeth as well. Sometimes it is associated with chest pain but occasionally it is not.
When a toothache has a cardiac origin, it usually increases with exercise and decreases with medication specific for your heart (such as nitroglycerin tablets). Treatment is directed to the underlying heart problem, usually after your dentist has evaluated the tooth.
Problems in the maxillary sinuses and/or paranasal mucosa can refer pain to the upper teeth. The pain is usually felt in several teeth as dull, aching or throbbing. Sometimes it is associated with pressure below the eyes and it can increase with lowering the head, putting pressure over the sinuses, coughing or sneezing. Tests performed on your teeth, such as cold, chewing and percussion, can increase the pain from sinus origin.
A history of an upper respiratory infection, nasal congestion or sinus problem should lead to suspicion of a "sinus tootache." Diagnostic tests, such as visual nasal exam, sinus X-rays or MRI, will reveal this condition. Also, application of topical anesthesia to the offending area should eliminate the pain. Treatment with antihistaminics, decongestants and antibiotics will help.
Neoplasias and Other Lesions in the Head
Some tumors, aneurisms (abnormality of a blood vessel), and other intracranial disorders can cause pain in your mouth or teeth. The tooth symptoms are generally accompanied by other nerve malfunctioning or systemic symptoms, such as weight loss, fatigue, etc. These accompanying symptoms suggest more than a localized tooth problem is occurring.
Tumors can also appear in the areas near the nerves of the teeth, which may cause the teeth to be loose or displaced. Proper imaging of the face, jaw and head is important to evaluate for these problems. Although possible, these problems are very rare, and treatment needs to be directed to the specific problem.
Salivary Gland Dysfunction
Patients with salivary gland dysfunction can experience dental pain through different mechanisms. It may occur through referred pain from the glands to the teeth. It may also occur through compromising the health of the teeth and supporting structures and by the absence of the protective saliva. In such case, a comprehensive evaluation of the salivary glands is needed.
J. Cohen, DDS, FACD
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