Pain of Odontogenic and Non-odontogenic Origin

  • Bobby Patel


Patients can present with pain of odontogenic or non-odontogenic origin, arising from the facial area, temporomandibular joints, ear, eyes, pharynx and larynx. Often they may be complaining of pain from their teeth. The dilemma the clinician faces is finding the correct origin of this pain whereby an effective treatment will provide relief. Patients with neuropathic orofacial pain may present to the clinician with a persistent, severe pain resulting in multiple endodontic procedures being instigated or worse still extractions recommended with no resolution of symptoms. The literature has demonstrated that the incidence of pain following endodontic treatment is between 3 and 6 % in the absence of reliable clinical and/or radiographic evidence of persisting disease. Management of orofacial pain is best by a multidisciplinary approach, and often the dentist is involved from the very beginning. Where patient toothache symptoms are not reproducible or clinical signs do not correlate, then a referral to an endodontist should be sought.


Root Canal Trigeminal Neuralgia Orofacial Pain Gingival Recession Root Canal Treatment 
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  1. 1.
  2. 2.
    Zakrzewska JM, Hamlyn PJ. Epidemiology of pain: facial pain. Seattle: IASP Press; 1999.Google Scholar
  3. 3.
    Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported oro-facial pain in the United States. J Am Dent Assoc. 1993;124:115–21.CrossRefPubMedGoogle Scholar
  4. 4.
    Macfarlane TV, Glenny A-M, Worthington HV. Systematic review of population based epidemiological studies of Orofacial Pain. J Dent. 2001;29:451–67.CrossRefPubMedGoogle Scholar
  5. 5.
    Macfarlane TV, Blinkhorn AS, Craven R, Zakrzewska JM, Aitkin P, Escudier MP, Rooney CA, Aggarwal V, Macfralane GJ. Can one predict the likely specific oro-facial pain syndrome from a self-completed questionnaire? Pain. 2004;11:270–7.CrossRefGoogle Scholar
  6. 6.
    Carotte P. Endodontics: part 2 diagnosis and treatment planning. Br Dent J. 2004;197(5):231–8.CrossRefGoogle Scholar
  7. 7.
    Walton RE, Torabinejad M. Principles and practice of endodontics. 3rd ed. Philadelphia/London: Saunders; 2002.Google Scholar
  8. 8.
    Byers MR. Dynamic plasticity of dental sensory nerve structure and cytochemistry. Arch Oral Biol. 1994;39(Suppl):13S–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Byers MR. Dental sensory receptors. Int Rev Neuorbiol. 1984;25:39–94.Google Scholar
  10. 10.
    Byers MR, Narhi MVO. Dental injury models: experimental tools for understanding neuro-inflammatory interactions and polymodal nociceptor functions. Crit Rev Oral Biol Med. 1999;10:4–39.CrossRefPubMedGoogle Scholar
  11. 11.
    Brannstom M. A hydrodynamic mechanism in the transmission of pain-producing stimuli through the dentine. In: Anderson DJ, editor. Sensory mechanisms in dentine. Oxford: Pergamon Press; 1963. p. 73–9.Google Scholar
  12. 12.
    Brannstrom M, Johnson G. Movements of the dentine and pulp liquids on application of thermal stimuli. An in vitro study. Acta Odontol Scand. 1970;28:59–70.CrossRefPubMedGoogle Scholar
  13. 13.
    Brannstrom M. The hydrodynamic theory of dentinal pain: sensations in preparations, caries and dentinal crack syndrome. J Endod. 1986;12:453–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Seltzer S, Bender IB, Zionitz M. The dynamics of pulpal inflammation: correlation between diagnostic data and actual histological findings in the pulp. Oral Surg Oral Med Oral Pathol. 1963;16:973–7.CrossRefGoogle Scholar
  15. 15.
    Trope M, Sigurdsson A. Clinical manifestations and diagnosis. In: Orstavik D, Pitt Ford TR, editors. Essential endodontology: prevention and treatment of apical periodontitis. Oxford: Blackwell Sciences; 1988. p. 157–78.Google Scholar
  16. 16.
    Addy M, Mostafa P, Absi EG, Adams D. Cervical dentine hypersensitivity. Aetiology and management with particular reference to dentifrices. In: Rowe NH, editor. Proceedings of symposium on hypersensitive dentine: origin and management. Ann Arbor: University of Michigan; 1985. p. 147–67.Google Scholar
  17. 17.
    Orchardson R, Collins WJN. Clinical features of hypersensitive teeth. Br Dent J. 1987;162:253–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Brannstrom M, Johnston G, Nordenvall K. Transmission and control of dentinal pain: resin impregnation for the desensitization of dentin. J Am Dent Assoc. 1979;99:612–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Kanapka J. Over the counter dentifrices in the treatment of dentinal hypersensitivity. Review of clinical studies. Dent Clin N Am. 1990;34:545–60.PubMedGoogle Scholar
  20. 20.
    Orchardson R, Gillam D. The efficacy of potassium salts as agents for treating dentine hypersensitivity. J Orofac Pain. 2000;14:9–19.PubMedGoogle Scholar
  21. 21.
    Dunne S, Hannington-Kiff J. The use of topical guanethidine in the relief of dentine hypersensitivity: a controlled study. Pain. 1993;54:165–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Dummer PMH, Hicks R, Huws D. Clinical signs and symptoms in pulp disease. Int Endod J. 1980;13:27–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Bender IB. Reversible and irreversible painful pulpitides: diagnosis and treatment. Aust Endod J. 2000;26:10–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Michaelson PL, Holland GR. Is pulpitis painless? Int Endod J. 2002;35:829–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Seltzer S, Bender IB, Zionitz M. The dynamics of pulp inflammation: correlations between diagnostic data and actual histopathological findings in the pulp. Oral Surg Oral Med Oral Pathol. 1963;16:969–77.CrossRefPubMedGoogle Scholar
  26. 26.
    Sandkuhler J. Models and mechanisms of hyperalgesia and allodynia. Physiol Rev. 2009;89:707–58.CrossRefPubMedGoogle Scholar
  27. 27.
    Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Int Assoc Study Pain. 2011;152:S2–15.Google Scholar
  28. 28.
    Hargreaves KM, Keiser K. Development of new pain management strategies. J Dent Educ. 2002;66:113–21.PubMedGoogle Scholar
  29. 29.
    Sessle BJ. Recent developments in pain research: central mechanisms of oro-facial pain and its control. J Endod. 1986;12:435–44.CrossRefPubMedGoogle Scholar
  30. 30.
    Balasubramaniam R, Turner LN, Fischer D, Klasser G, Okeson JP. Non-odontogenic toothache revisited. Open J Stomatol. 2011;1:92–102.CrossRefGoogle Scholar
  31. 31.
    Hauman CHJ, Chandler NP, Tong DC. Endodontic implications of the maxillary sinus: a review. Int J Endod. 2002;35:127–41.CrossRefGoogle Scholar
  32. 32.
    Vickers ER, Zakrzewska JM. Dental causes of oro-facial pain. In: Zakrzewska JM, editor. Orofacial pain. Oxford: Oxford University Press; 2009. p. 69–81.CrossRefGoogle Scholar
  33. 33.
    Drangsholt M, LeResche L. Temporomandibular disorder pain. In: Crombie I, Linton SJ, LeResche L, von Korff M, editors. Epidemiology of pain. Seattle: IASP Press; 1999. p. 203–33.Google Scholar
  34. 34.
    Gesch D, Bernhardt O, Kirbschus A. Association of malocclusion and functional occlusion with temporomandibular disorders (TMD) in adults: a systematic review of population-based studies. Quintessence Int. 2004;35:211–21.PubMedGoogle Scholar
  35. 35.
    Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular joint disorders. Cochrane Database Syst Rev. 2009;(4):CD004973.Google Scholar
  36. 36.
    Law AS, Lilly JP. Trigeminal neuralgia mimicking odontogenic pain. A report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80:96–100.CrossRefPubMedGoogle Scholar
  37. 37.
    Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15:1013–28.CrossRefPubMedGoogle Scholar
  38. 38.
    Wiffen PJ, Derry S, Moore RA, McQuay, HJ. Carbamazepine for acute and chronic pain in adults. Cochrane Database Syst Rev. 2011;(1):CD005451.Google Scholar
  39. 39.
    Zakrzewska JM, Coakham HB. Microvascular decompression for trigeminal neuralgia: update. Curr Opin Neurol. 2012;25:296–301.CrossRefPubMedGoogle Scholar
  40. 40.
    Baad-Hansen L. Atypical odontalgia – pathophysiology and clinical management. J Oral Rehabil. 2008;35:1–11.CrossRefPubMedGoogle Scholar
  41. 41.
    Abiko Y, Matsuoka H, Chiba I, Toyofuku A. Current evidence on atypical odontalgia: diagnosis and clinical management. Int J Dent. 2012;2012:518548.CrossRefPubMedCentralPubMedGoogle Scholar
  42. 42.
    List A, Feinmann C. Persistent idiopathic facial pain (atypical facial pain). In: Zakrzewska JM, editor. Orofacial pain. Oxford: Oxford University Press; 2009.Google Scholar
  43. 43.
    Harrison SD, Glover L, Feinmann C, Pearce SA, Harris M. A comparison of antidepressant medication alone and in conjunction with cognitive behavioural therapy for chronic idiopathic facial pain. In: Turner JA, Wiesenfeld-Hallin Z, Jensen TS, editors. Proceedings of the eighth world congress on pain. Progress in pain research and management. Seattle: IASP Press; 1997. p. 663–72.Google Scholar
  44. 44.
    Nixdorf DR, Moana-Filho EJ, Law AS, Mcguire LA, Hodges JS, John MT. Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis. J Endod. 2010;36:224–30.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Nixdorf DR, Moana-Filho EJ, Law AS, Mcguire LA, Hodges JS, John MT. Frequency of non-odontogenic pain after endodontic therapy: a systematic review and meta-analysis. J Endod. 2010;36:1494–8.CrossRefPubMedCentralPubMedGoogle Scholar
  46. 46.
    Zakrzewska JM. Multidimensionality of chronic pain of the oral cavity and face. J Headache Pain. 2013;14:37.CrossRefPubMedCentralPubMedGoogle Scholar
  47. 47.
    Southwood LL. The challenge with diagnosing rare diseases: the ‘zebra’ diagnosis. Equine Vet Educ. 2014;26:559–60. doi: 10.1111/eve.12059.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Bobby Patel
    • 1
  1. 1.CanberraAustralia

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