No matter what your dentist may do the pain never goes, this kind of situation can occur with any unfortunate patient, he or she complains and complains, dentist tries and tries but pain still persists.
Finally the tooth is extracted but pain is still present? Now everyone start to think what can be the problem other then toothache.
Human cranium is one of the most complex things nature have developed and faults may occur even by nature, huge number of nerve supply and synaps are present in our brain and slightest problem in any one of them will result in intense pain.
Pain is protective mechanism of the body which tells us there is something wrong inside there? we need to correct it.
I have collected and listed 3 neuropathic orofacial pain which can be misunderstood as toothache or dental pain.
Trigeminal neuralgia which is also known as tic douloureux, is a sharp, stabbing or lancination pain arising i norofacial region which is supplied by trigeminal nerve. 8 people in 100000 will show up with TN, This condition is mostly seen in patients who are above 50 years, females are slightly more affected by this condition.
Clinical feature-
Sharp, electric shock like pain which lasts for seconds to 1 minute followed by refractory period which feels like burning pain.
Trigger zone- corner of the lip, lateral brow, ala of the nose
Soft touch in any of these regions will trigger the attack.
Dental pain in the area which does not show any abnormalities in physical or radiographic change, pain is same as TN- sharp, electric shock like. Pain usually subsides when local anesthetic is applied in the affected area
Clinical features-
Aching or burning pain
Continuous or intermittent
Unilateral location
Local anesthetic of pain full region arrests the pain
Neurologic examination normal
No dentoalveolar cause found
Responsive to anticonvulsant therapy
This type of pain occur when there is damage to the afferent pain transmission system. It is usually caused by trauma or surgery including extraction and endodontic treatment.
Similar type of pain occur after amputation of limb which is called as phantom pain.
This pain may occur after extraction or endodontic treatment because they involve amputation of tissue which contain nerve supply of a human structure.
Clinical feature-
Burning or aching pain which is continuous.
Allodynia, hyperesthesia, hypoesthesia
No dento alveolar cause
History of surgery or trauma
Symptoms for 4 to 6 months
Local anesthetic block not so effective
Complete discussion and evaluation should be done before any dental treatment.
Finally the tooth is extracted but pain is still present? Now everyone start to think what can be the problem other then toothache.
Human cranium is one of the most complex things nature have developed and faults may occur even by nature, huge number of nerve supply and synaps are present in our brain and slightest problem in any one of them will result in intense pain.
Pain is protective mechanism of the body which tells us there is something wrong inside there? we need to correct it.
I have collected and listed 3 neuropathic orofacial pain which can be misunderstood as toothache or dental pain.
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| Trigeminal Nerve Supply Source: www.neurosurgery.oshu.edu |
1. Trigeminal Neuralgia
Trigeminal neuralgia which is also known as tic douloureux, is a sharp, stabbing or lancination pain arising i norofacial region which is supplied by trigeminal nerve. 8 people in 100000 will show up with TN, This condition is mostly seen in patients who are above 50 years, females are slightly more affected by this condition.
Clinical feature-
Sharp, electric shock like pain which lasts for seconds to 1 minute followed by refractory period which feels like burning pain.
Trigger zone- corner of the lip, lateral brow, ala of the nose
Soft touch in any of these regions will trigger the attack.
2. Pretrigeminal Neuralgia
Dental pain in the area which does not show any abnormalities in physical or radiographic change, pain is same as TN- sharp, electric shock like. Pain usually subsides when local anesthetic is applied in the affected area
Clinical features-
Aching or burning pain
Continuous or intermittent
Unilateral location
Local anesthetic of pain full region arrests the pain
Neurologic examination normal
No dentoalveolar cause found
Responsive to anticonvulsant therapy
3. Odontalgia Resulting From Deaffernation ( Atypical Odontalgia)
This type of pain occur when there is damage to the afferent pain transmission system. It is usually caused by trauma or surgery including extraction and endodontic treatment.
Similar type of pain occur after amputation of limb which is called as phantom pain.
This pain may occur after extraction or endodontic treatment because they involve amputation of tissue which contain nerve supply of a human structure.
Clinical feature-
Burning or aching pain which is continuous.
Allodynia, hyperesthesia, hypoesthesia
No dento alveolar cause
History of surgery or trauma
Symptoms for 4 to 6 months
Local anesthetic block not so effective
Conclusion-
All the above conditions can be recognized and un needed dental treatment can be avoided by taking excellent description of chief complain , quality of pain, duration, trigger agents, history of the problem over chronological fashion should be noted and contemplated.Complete discussion and evaluation should be done before any dental treatment.