Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지
DOI QR코드

DOI QR Code

Analysis of Final Diagnosis of Patients with Suspected Nonodontogenic Toothache: A Retrospective Study

  • Jeong Yeop Chun (Department of Oral Medicine, Wonkwang University Daejeon Dental Hospital) ;
  • Young Joo Shim (Department of Oral Medicine, Wonkwang University Daejeon Dental Hospital)
  • Received : 2024.08.19
  • Accepted : 2024.09.06
  • Published : 2024.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study is to analyze the final diagnosis and the pain characteristics of patients with suspected nonodontogenic toothache and to contribute to the knowledge on differential diagnosis. Methods: A retrospective analysis was conducted based on medical records from 185 patients. The following data were collected: age, sex, pain characteristics, radiographic results, initial diagnosis and treatment, and final diagnosis and treatment. The final diagnosis and the pain characteristics of the 3 most common final diagnoses were analyzed. Results: Myofascial pain (MFP) was the most prevalent diagnosed condition accounting for 37.8% of cases, followed by pulpal pain (P) at 31.4%, and trigeminal neuralgia (TN) at 18.9%. There were significant differences in age, onset of the pain, and pain intensity across the 3 groups (all p<0.01). TN group exhibited a lower frequency of spontaneous and continuous pain than the MFP and P groups (all p<0.001). The proportion of patients reporting pain alleviating and aggravating factors related to dental pain was significantly higher in the P group than in the MFP and TN groups (all p<0.001). A concordance rate of 57.0% was observed between the initial and the final diagnosis. Twenty-six patients underwent tooth extractions and 24 patients had root canal treatments. Conclusions: It is important to differentiate between dental pain and nonodontogenic toothache to avoid unnecessary dental treatments. Comprehending the pain characteristics of each condition, taking a thorough history taking, and performing diagnostic tests can help differential diagnosis.

Keywords

Acknowledgement

This study was supported by Wonkwang University in 2024.

References

  1. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115-121. 
  2. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia 2020;40:129-221.  https://doi.org/10.1177/0333102419893823
  3. Okeson JP. Dental pains. In: Okeson JP, ed. Bell's oral and facial pain. 7th ed. Quintessence Publishing Co., Inc.; 2014. pp. 249-285. 
  4. Yatani H, Komiyama O, Matsuka Y, et al. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil 2014;41:843-852.  https://doi.org/10.1111/joor.12208
  5. Michaelson PL, Holland GR. Is pulpitis painful? Int Endod J 2002;35:829-832.  https://doi.org/10.1046/j.1365-2591.2002.00579.x
  6. Hasler JE, Mitchell DF. Painless pulpitis. J Am Dent Assoc 1970;81:671-677.  https://doi.org/10.14219/jada.archive.1970.0293
  7. Nixdorf DR, Moana-Filho EJ, Law AS, McGuire LA, Hodges JS, John MT. Frequency of nonodontogenic pain after endodontic therapy: a systematic review and meta-analysis. J Endod 2010;36:1494-1498.  https://doi.org/10.1016/j.joen.2010.06.020
  8. Vena DA, Collie D, Wu H, et al.; PEARL Network Group. Prevalence of persistent pain 3 to 5 years post primary root canal therapy and its impact on oral health-related quality of life: PEARL Network findings. J Endod 2014;40:1917-1921.  https://doi.org/10.1016/j.joen.2014.07.026
  9. Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 2005;38:169-178.  https://doi.org/10.1111/j.1365-2591.2004.00923.x
  10. Park HO, Ha JH, Jin MU, Kim YK, Kim SK. Diagnostic challenges of nonodontogenic toothache. Restor Dent Endod 2012;37:170-174.  https://doi.org/10.5395/rde.2012.37.3.170
  11. Duffin PS, Smith A, Hawkins JM. Nonodontogenic odontalgia referred from the temporal tendon: a case report. J Endod 2020;46:1530-1534.  https://doi.org/10.1016/j.joen.2020.06.006
  12. Mehrkhodavandi N, Green D, Amato R. Toothache caused by trigeminal neuralgia of vestibular schwannoma: a case report. [Corrected]. J Endod 2014;40:1691-1694.  https://doi.org/10.1016/j.joen.2014.03.008
  13. Okeson JP. Functional neuroanatomy and physiology of masticatory system. In: Okeson JP, ed. Management of temporomandibular disorders and occlusion. 8th ed. Elsevier Health Sciences; 2019. pp. 40-43. 
  14. Okeson JP. Pains of muscle origin. In: Okeson JP, ed. Bell's oral and facial pain. 7th ed. Quintessence Publishing Co., Inc.; 2014. pp. 294-305. 
  15. Simons DG, Travell JG, Simons LS. General overview. In: Simons DG, Travell JG, Simons LS, eds. Myofascial pain and dysfunction: the trigger point manual (Vol. 1). 2nd ed. Williams & Wilkins; 1999. pp. 11-93. 
  16. Wright EF. Referred craniofacial pain patterns in patients with temporomandibular disorder. J Am Dent Assoc 2000;131:1307-1315.  https://doi.org/10.14219/jada.archive.2000.0384
  17. Schiffman E, Ohrbach R, Truelove E, et al.; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group†. J Oral Facial Pain Headache 2014;28:6-27.  https://doi.org/10.11607/jop.1151
  18. Myburgh C, Larsen AH, Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil 2008;89:1169-1176.  https://doi.org/10.1016/j.apmr.2007.12.033
  19. Kim ST. Myofascial pain and toothaches. Aust Endod J 2005;31:106-110.  https://doi.org/10.1111/j.1747-4477.2005.tb00315.x
  20. American Academy of Endodontics. AAE consensus conference recommended diagnostic terminology. J Endod 2009:35;1634. 
  21. Donnermeyer D, Dammaschke T, Lipski M, Schafer E. Effectiveness of diagnosing pulpitis: a systematic review. Int Endod J 2023;56(Suppl 3):296-325.  https://doi.org/10.1111/iej.13762
  22. Elias WJ, Burchiel KJ. Trigeminal neuralgia and other neuropathic pain syndromes of the head and face. Curr Pain Headache Rep 2002;6:115-124.  https://doi.org/10.1007/s11916-002-0007-8
  23. Zakrzewska JM. Diagnosis and differential diagnosis of trigeminal neuralgia. Clin J Pain 2002;18:14-21.  https://doi.org/10.1097/00002508-200201000-00003
  24. Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia: a prospective systematic study of clinical characteristics in 158 patients. Headache 2014;54:1574-1582.  https://doi.org/10.1111/head.12441
  25. von Eckardstein KL, Keil M, Rohde V. Unnecessary dental procedures as a consequence of trigeminal neuralgia. Neurosurg Rev 2015;38:355-360; discussion 360.  https://doi.org/10.1007/s10143-014-0591-1
  26. Farella M, Michelotti A, Gargano A, Cimino R, Ramaglia L. Myofascial pain syndrome misdiagnosed as odontogenic pain: a case report. Cranio 2002;20:307-311.  https://doi.org/10.1080/08869634.2002.11746224
  27. 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.  https://doi.org/10.1016/S1079-2104(95)80024-7
  28. Linn J, Trantor I, Teo N, Thanigaivel R, Goss AN. The differential diagnosis of toothache from other orofacial pains in clinical practice. Aust Dent J 2007;52(1 Suppl):S100-S104.