When Patients Present With Confusing Pain

Typically tooth-related pain that presents in our office is pretty straightforward to diagnose and treat. But sometimes we see patients that are in 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 normal.

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

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

T​​rigeminal Neuralgia/Neuralgias: This condition involves the inflammation and/or a disorder of the Trigeminal Nerve, which is responsible for giving sensation to the oral cavity and surrounding structures. Usually these patients have a sharp, stabbing pain that can be 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 yet it can be a common finding in patients that 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 is a condition that is as a result of inflammation of blood vessels in the head, especially the branches of the external carotid artery. 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 to be related to their teeth.

Pathological Disease: Cancer and growth in the jaws can lead to pain, tooth mobility and swelling in the jaw, all mimicking common tooth issues and can be often 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 they also have pain and soreness in the cheek area. Usually they have a history of increased congestion and/or drainage from the sinuses and may be even running a low grade fever and feel poor overall. Typical findings include upper teeth 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 and it resolves shortly after eating. The pain is usually non-specific and they point 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 has now become infected due to poor drainage.

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Jeff Lineberry, D.D.S., F.A.G.D., Spear Visiting Faculty and Contributing Author, and accredited member of the AACD - https://cccdds.com/