When Patients Present With Confusing Pain

Typically, tooth-related pain in our office is pretty straightforward to diagnose and treat. But sometimes, we see patients with pain that feels like it’s in their teeth or coming from surrounding structures, but it’s actually not.

The most critical component of a diagnosis is getting a clear history and, if possible, reproducing the pain. If you do all of your regular tests and find yourself still scratching your head trying to figure things out, consider these other potential causes:

Periodontal Abscess: Sometimes, patients develop pain and discomfort from the surrounding structures but not from the tooth itself. A common finding is a dull pain and swelling around a tooth that has bone loss and is healthy otherwise, and when tested, the nerve responds normally.

Bruxism/Occlusal issues: Clenching the teeth at night, day, or both, along with imbalances in a patient’s bite, can trigger a whole host of issues, including pain when biting, sensitivity, transient sensitivity, and fractured and mobile teeth. Often, these patients also have TMD/TMJ issues.

TMD/TMJ Pain: Patients with TMD issues can complain of simple soreness in teeth, radiating pain from muscle spasms, jaw pain, pain radiating into the ear area, and the list goes on. They often have “trigger points” or tender areas that can even refer pain to the affected teeth.

T​​rigeminal Neuralgia/Neuralgias: This condition involves inflammation and/or a trigeminal nerve disorder, which is responsible for giving sensation to the oral cavity and surrounding structures. Usually, these patients have a sharp, stabbing pain caused by touch, eating, chewing, drinking, and brushing of teeth, even from wind blowing against the skin.

Cardiovascular Event: We don’t usually think about our hearts causing pain in the jaw, but it can be a common finding in patients who are having a heart attack. Often, we think of patients having pain in the chest along with nausea, fatigue, and shortness of breath. But recent studies show that females usually do not have chest pain, but will have other types of pain, such as pain in the jaw and neck areas, when they are having a heart attack

Temporal Arteritis: This condition results from inflammation of blood vessels in the head, especially the external carotid artery branches. These patients can have a history of headaches, but they also can have pain in their heads and jaws, as well as their tongues, when chewing. This can prompt them to show up in your office first, since most people associate issues with chewing with their teeth.

Pathological Disease: Cancer and growth in the jaws can lead to pain, tooth mobility, and swelling, all of which mimic common tooth issues and can often be overlooked or misdiagnosed. Sometimes, these areas can also get infected, causing pain and swelling that can often seem like a regular tooth problem.

Sinus Infection: These patients come in complaining of soreness in the upper posterior teeth, but also have pain and soreness in the cheek area. Usually, they have a history of increased congestion and/or drainage from the sinuses, may even be running a low-grade fever, and feel poor overall. Typical findings include upper teeth that are generally all sore to touch/percussion on the affected side (sometimes both), but there is not a specific tooth that is more sensitive, and they usually have normal thermal tests.

Salivary Glands: Not seen often, these patients usually come in complaining that when they eat, they feel swelling and discomfort, which resolves shortly after eating. The pain is usually non-specific and points to a general area like the side of their face or under their jaw. Sweet or sour foods are the most common ones that trigger the problem. This is often due to a salivary stone that has caused blockage of the duct and/or the gland, which has become infected due to poor drainage.