Background & Aims

Odontogenic toothache is the most common cause of orofacial pain. The most common cause is inflammation of the pulp and periodontal tissues. However, there are some cases which the pain felt in the teeth is not caused by the teeth, but by other structures. The causes of non-odontogenic toothache include myofascial, sinus/nasal mucosal, neuropathic, neurovascular, cardiac, psychogenic, and systemic origin. In this study, we analyzed the final diagnosis of patients who visited or were referred to an orofacial pain specialist for suspected non-odontogenic toothache and provide a guide to differentiate between odontogenic and non-odontogenic toothache.

Methods

This is a retrospective study based on the medical records of clinical pain characteristics and treatment outcomes of 185 patients with the chief complaint of pain on teeth and gingiva who visited an orofacial pain specialist. Demographics, pain characteristics (including pain site, duration, triggering and alleviating/aggravating factors), radiographic findings, tentative diagnosis (prior to referral or visit to an orofacial pain specialist), previous treatment and treatment outcomes of that, final diagnosis by orofacial pain specialist and endodontist, treatment after final diagnosis, and treatment outcomes were analyzed. All p-values of <0.05 were considered to be statistically significant.

Results

Of the 185 subjects, 122 (65.94 %) were female and 63 (34.05%) were male. The average age was 49.8 years. The most common final diagnosis was myofascial pain (MFP) (37.8%, n=70), followed by pulpal pain (P) (n=58, 31.4%), and trigeminal neuralgia (TN) (n=35, 18.9%). 37% of the patients with non-odontogenic toothache were finally diagnosed with odontogenic pain. The patients with TN were older than MFP and P groups (p=0.005). Pain duration in TN and P groups was shorter than that of in MFP group (p <0.001). Pain intensity in TN and P groups was higher than that of in MFP group (p <0.001). There was no differences of pain intensity between TN and P groups (p=0.965). The proportion of patient with continuous and spontaneous pain in MFP and P groups was significantly higher than that of in TN group (all p <0.001). Patients who had extraction and root canal treatment were 26 and 35 patients. Patients who had extraction were finally diagnosed with MFP (n=12) and TN (n=8).

Conclusions

The most common final diagnosis was myofascial pain. Pulpal pain accounted for about one-third of the cases, which means that in the absence of typical radiographic abnormalities, pulpal pain is often misdiagnosed as MFP or TN. The clinician should be aware of the different causes of tooth pain and the characteristics of each pain type to make an accurate differential diagnosis.

References

Yatani H, Komiyama O, Matsuka Y, Wajima K, Muraoka W, Ikawa M, Sakamoto E, De Laat A, Heir GM. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil. 2014 Nov;41(11):843-52.
Renton T. Tooth-Related Pain or Not? Headache. 2020 Jan;60(1):235-246.
De Laat A. Differential diagnosis of toothache to prevent erroneous and unnecessary dental treatment. J Oral Rehabil. 2020 Jun;47(6):775-781.
Erdogan O, Ramsey A, Uyanik JM, Gibbs JL, Burns LE. Outcomes of referrals from endodontic to orofacial pain specialists: A retrospective cohort study. Clin Exp Dent Res. 2022 Feb;8(1):457-463.

Presenting Author

Young Joo Shim

Poster Authors

Young Joo Shim (PhD)

Ph.D

Department of Oral Medicine, Daejeon Dental Hospital, College of dentistry, Wonkwang University

Lead Author

Hye Kyoung Kim

Department of Orofacial Pain and Oral Medicine, School of Dentistry

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain