Facial pain is not necessarily due to inflammation of the tooth pulp or periapical tissues. Other diseases that manifest themselves in pain are: temporomandibular joint disorders, sinusitis, trigeminal neuralgia, trigeminal neuritis, prune glandulitis, hemiplegia or angina pectoris.
Table of contents:
- Temporomandibular joint disorders
- Sinusitis
- Trigeminal neuralgia
- Trigeminal nerve inflammation
- Diseases of the salivary glands
- Hemiplegia
- Pustachycardia
Disorders of the temporomandibular joint
Manifested by long-lasting, chronic pain in the ear, temple and neck area, usually characterised as dull and diffuse. Examination of the masseter muscle attachments causes soreness. During dilation there may be a deviation of the mandible and a characteristic "snap" may be heard. In order to differentiate whether the pain is coming from a tooth, the following tests should be carried out: electrical, thermal stimulus and tapping. The teeth will respond correctly.
Sinusitis
With sinusitis, the pain is diffuse and occurs when the head is bent forward. Tooth percussion may give a false positive response as it can cause rapid movement of fluid in the sinus. It is also important to remember that teeth in the sinus area have a reduced threshold of cold excitability. Pressure on the trigeminal nerve outlet can cause pain in many teeth. A nasal exudate present will help in differentiating the origin of the pain.
Trigeminal neuralgia
In this condition the pain is sudden, acute, brief and of very high intensity. It causes characteristic reflexes and nerve tics and does not occur at night. The pain can be caused by touch or even a gust of wind. The pain symptoms appear cyclic, and there may be remissions of several months. Neuropathic pain is most common in women over 50 years of age. Teeth should respond correctly to stimuli.
Trigeminal neuritis
Inflammation is characterised by constant pain of low to moderate intensity. It lasts for about 10 days. The cause may be a bacterial or viral infection, or local factors such as pulpitis or sinus or salivary gland inflammation.
Diseases of the salivary glands
The main complaints are pain when eating (starts before eating, then intensifies). The gland shows reduced salivary secretion or a complete absence of saliva. Swelling due to infection or salivary gland blockage may be evident. During the differentiation, an occlusal radiograph may be useful, on which a stone blocking the salivary gland may become visible. Teeth should respond correctly to thermal stimuli.
Toothache, photo by panthermedia
Hemiplegia
This is a viral disease that manifests itself as a very severe pain on a section of the affected nerves. This is followed by the appearance of vesicles on one side of the body.
Etiological factors are older age, reduced immunity, stress. When the patient does not yet have pathological changes on the mucosa (vesicles), differentiation is difficult. When two or more teeth are in pain, pulp vitality testing is not reliable. Once vesicles have appeared, there is unlikely to be a problem in differentiating the origin of the pain.
Painful angina
In 18% of patients with angina, the pain manifests itself only in the mandible. The pain does not occur in a specific tooth, but is located in the mandibular body. It occurs during physical exertion or stress. The teeth should respond correctly to stimuli. The patient requires immediate medical attention.
