Non-Dental Mediated Odontalgia: A Critical Review

Background: Although the overwhelming majority of dental pain is odontogenic in origin, a significant percentage is nonodontogenic. Toothache of nonodontogenic origin is not true dental pathology; rather, it is pain referred to the dentition from another location. Objective: To review reports of cases of non dental mediated odontalgia from the last 10 years, focusing on the epidemiology, clinical characteristics, etiology, and pathophysiology of the origins that might cause pain referral to the teeth. Methods: A search of the literature was performed in MEDLINE for all cases of toothache from non dental origin in the English language from the last 10 years. Results: The following articles were reviewed: Neuropathic pain: 10 clinical studies and 2 review articles; Psychogenic pain: 5 studies;Cardiac pain: 4 studies; Sinus or nasal mucosa pain: 3 studies;Muscular pain:2 studies; Neurovascular pain: 9 studies. In some of the patients mentioned above, the chief complaint was of toothache. Because of mistaken diagnoses many unnecessary dental procedures were performed. Only after the correct diagnosis, followed by the correct treatment, an improvement in pain occurred. Conclusion: Pain can be present in any region of the trigeminal neurosensory distribution, including the teeth and jaws. Patients may present to their dentist for evaluation and treatment of a suspected odontogenic reason for their toothache. Often, by the time they see an Orofacial Pain practitioner they have received multiple unsuccessful and irreversible dental treatments in hopes of alleviating their pain. It is important that dentists be able to identify referred pain from non dental origin masquerading as toothache before implementing traditional dental treatments.