Neuropathic Pain Conditions Affecting Teeth - A Review For General Dentist.

ABSTRACT

The majority of toothaches originate in either the dental pulp tissues or the supporting periodontal structures. These pains of dental origin (odontogenic) are reasonably easy to diagnose and can be managed with regular dental procedures which includes endodontic treatment or extractions. Nonodontogenic neuropathic pains in the maxillofacial complex are challenging, as the differential diagnosis can include paroxysmal conditions. Frequently, dentists may face the complex challenge to diagnose and treat pain of a neuropathic origin in the orofacial region. This article reviews management of various neuropathic pain conditions that affect orofacial structures, including such conditions as atypical odontalgia (AO), trigeminal neuralgia (TN), and glossopharyngeal neuralgia (GPN). The above conditions should be considered during an endodontic evaluation when patients complain of dental pain with no obvious pathology. To determine the source of the pain, the dentist needs to obtain a detailed medical history that includes information about the condition’s duration, severity, pattern, and relieving factors. A thorough intraoral and extraoral clinical examination is mandatory to rule out odontogenic causes. Based on the pain history and the clinical examination, radiographic and other investigative procedures may be necessary to diagnose the condition. A good knowledge of nonodontogenic causes of pain may prevent unnecessary irreversible dental treatment. The diagnosis and management of nonodontogenic pain usually requires a multidisciplinary team approach involving a dentist, a neurologist, and an otolaryngologist.