Atypical Tooth & Facial Pain

Atypical Tooth and Facial Pain is a catch-all diagnosis that encompasses many different disorders. Tooth and facial pain is most commonly caused by dental pathology therefore most patients with these disorders are frequently seen by dentists originally. An accurate diagnosis is very important as an erroneous diagnosis commonly leads to unnecessary dental treatment. Pain can arise from any of the numerous structures within the orofacial region making diagnosis very complicated. Therefore it is important to see a healthcare provider specially trained to identify structures within the orofacial region. Outlined below are some of the causes of Atypical Tooth and Facial Pain:

1. Trigeminal Neuralgia: (See Trigeminal Neuralgia)
    
2. Trigeminal Neuritis: Is felt as a continuous burning pain along the distribution of the Trigeminal Nerve. It is the result of inflammation within the nerve from trauma, bacterial, viral, or toxins. Numbness, tingling and hypersensitivity around the affected area can accompany the pain. Treatment can include medications and injections aimed at eliminating the inflammation around the nerve. Herpes-Zoster is a form of neuritis, which also produces small vesicles along the distribution of the nerve. These vesicles are present 4-5 days after the onset of pain. Ramsay-Hunt syndrome is similar but affect the facial nerve and the vesicle are located in the ear and throat.
    
3. Trigeminal Deafferentation Pain: Are most commonly the effect of direct trauma or surgical procedures, which disrupt the trigeminal nerve. Dental extractions are the most common cause but it has also been seen with local anesthetic injections, root canals and routine dental fillings. The pain is felt as a constant aching to burning pain, which can be accompanied by numbness, tingling and hypersensitivity around the affected area. Unlike it Trigeminal Neuralgia there is no noticeable trigger for the pain. This disorder can be classified as either Traumatic Neuralgia of Atypical Odontalgia. Anesthesia Dolorosa is an area of anesthesia with intractable pain, which usually is the result of damage to the nerve following a surgical procedure. Treatment can involve medications to stabilize the nerve and therapeutic injections. If a neuroma is present than surgical considerations are given.
    
4. Sympathetically Maintained Pain: Also called reflex sympathetic dystrophy (RSD), complex regional pain syndrome, or causalgia is described as a continuous burning pain that usually follows some type of trauma to area. Any stimulation of the excitatory nervous system such as in fear or anxiety can exacerbate this condition. Although relatively uncommon within the orofacial region, it is confirmed by blockade of the sympathetic stellate ganglion.
    
5. Post-herpetic neuralgia: This condition occurs mainly id people over 40 and may affect 75% of the population by age 90 with a previous exposure to the chicken-pox. It is felt as a moderate burning pain that may spontaneously come and go. Management of this disorder can be difficult especially if pain persists for over 1 year.
    
6. Temporal Arteritis: Is felt as an intense aching, throbbing or burning pain, typically on only one side of the head, that can become sharp pain with pressure. The pain may be constant or intermittent. This pain comes from inflammation within the temporal artery. This needs to be promptly diagnosed as it can lead to partial or total blindness within the affected eye. This disorder is treated with steroid medications.
    
7. Carotidynia: This pulsating pain arises from the carotid artery within the neck and is felt as anterior neck pain radiating into the face and ear. Placing pressure over the artery on the neck can increase the pain. This disorder is treated with steroid medications.
    
8. Eustachian Tube Dysfunction: Is felt as a deep sharp to aching pain in the ear and throat region. This can be caused by dysfunction within the middle ear or by the muscles, which control the opening of the tube. Often there is a characteristic clicking noise that can be made with yawning or wide opening.
    
9. Eagle's Syndrome: This is felt as a stabbing pain in the throat that can radiate into the face. It is made worse by bending the head forward and toward the side of pain. This comes from the calcification of a normally soft ligament that attaches to the lower jawbone.  Surgery is indicated for this disorder.
    
10. Incomplete Tooth Fracture: This sometimes difficult to diagnose problem is relatively common. It comes from a partial fracture within the tooth that hurts only when pressure is applied to the tooth in a certain way. X-rays are usually of no benefit. Treatment is with a crown and/or root canal.
     
11. Traumatic occlusion: This is an aching to sharp pain in and around a tooth. It is made worse by clenching on the tooth. This can be a result of teeth clenching or grinding or a bad dental bite.
     
12. Paroxysmal Hemicrania: It is a unilateral sharp shooting pain accompanied by a stuffy and runny nose and tearing and redness of the eye on the same side as the pain. It is most common in women in their thirties and can be exacerbated by moving the head. It is characteristically responsive to Indomethacin.
     
13. Myofacial Pain: (See Myofacial Pain)
     
14. TMJ Disorders: (See TMJ Disorders)
     
15. Migraine Headache: (See Headaches)
     
16. Cluster Headache: (See Headaches)
     
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