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signs and symptoms of non - odontogenic :

1- Trigeminal neuralgia : is a chronic pain condition that affects the trigeminal nerve,
which carries sensation from your face to your brain. If you have trigeminal neuralgia,
even mild stimulation of your face — such as from brushing your teeth or putting on
makeup — may trigger a jolt of excruciating pain

Trigeminal neuralgia symptoms may include one or more of these patterns:

 Episodes of severe, shooting or jabbing pain that may feel like an electric shock

 Spontaneous attacks of pain or attacks triggered by things such as touching the

face, chewing, speaking or brushing teeth

 Bouts of pain lasting from a few seconds to several minutes

 Episodes of several attacks lasting days, weeks, months or longer — some people
have periods when they experience no pain

 Constant aching, burning feeling that may occur before it evolves into the spasm-
like pain of trigeminal neuralgia

 Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth,
gums, lips, or less often the eye and forehead

 Pain affecting one side of the face at a time, though may rarely affect both sides of
the face

 Pain focused in one spot or spread in a wider pattern

 Attacks that become more frequent and intense over time .

2- myocardial pain : occurs when the flow of blood to the heart is blocked. The
blockage is most often a buildup of fat, cholesterol and other substances, which form a
plaque in the arteries that feed the heart (coronary arteries). The plaque eventually
breaks away and forms a clot. The interrupted blood flow can damage or destroy
part of the heart muscle.

Common heart attack signs and symptoms include:

 Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms

that may spread to your neck, jaw or back

 Nausea, indigestion, heartburn or abdominal pain

 Shortness of breath

 Cold sweat

 Fatigue

 Lightheadedness or sudden dizziness

3- Maxillary sinusitis : Sinusitis is an inflammation or swelling of the tissue
lining the sinuses. Healthy sinuses are filled with air. But when they become
blocked and filled with fluid, germs can grow and cause an infection.

Acute Sinusitis Symptoms

The main signs include:

 Facial pain or pressure

 "Stuffed-up" nose
 Runny nose
 Loss of smell
 Cough or congestion

You may also have:

 Fever
 Bad breath
 Fatigue
 Dental pain

It may be acute sinusitis if you have two or more symptoms, or thick, green, or yellow nasal

Chronic Sinusitis Symptoms

You may have these symptoms for 12 weeks or more:

 A feeling of congestion or fullness in your face

 A nasal obstruction or nasal blockage
 Pus in the nasal cavity
 Fever
 Runny nose or discolored postnasal drainage
4- atypical facial pain : Atypical facial pain (AFP) was an umbrella term used to
categorize all facial pains that didn’t mimic the classic symptoms of ( trigeminal
neuralgia) — severe pain that could last seconds or minutes and be brought on by triggers.
In recent years, however, AFP has come to describe facial pain with no known cause.

Symptoms :
- Facial pain — The pain may be sporadic, but in many cases it is constant. Some sort
of trigger, such as moving, eating, wind or being touched, frequently brings it on.
The pain produces burning, stabbing, shooting or electric-shock sensations and may
result in itching or tingling.

5- phantom tooth pain : also known as Atypical odontalgia and atypical

facial pain is characterized by chronic pain in a tooth or teeth, or in a site
where teeth have been extracted or following endodontic treatment, without an
identifiable cause. Over time, the pain may spread to involve wider areas of the face
or jaws.

The pain is called “atypical” because it is a different type of pain than that of a typical
toothache. Typical toothache comes and goes and is aggravated by exposure of the tooth
to hot or cold food or drink, and/or by chewing or biting on the affected tooth. There is an
identifiable cause, such as decay, periodontal disease, or injury to the tooth and the pain is
predictably relieved by treatment of the affected tooth.

symptoms include :

sensations often described as

 burning,
 pulsing,
 crushing,
 throbbing,
 itching,
 pins-and-needles tingling,
 aching
 pulling.

The condition can manifest in any part of the face, but the most common area is around
the jaw and sides of the face
6- Herpes zoster : is a painful rash that develops on one side of the face or
body. The rash consists of blisters that typically scab over in 7 to 10 days.
The rash usually clears up within 2 to 4 weeks. Before the rash develops,
people often have pain, itching, or tingling in the area where the rash will
develop. This may happen anywhere from 1 to 5 days before the rash

Symptoms :

 Fever
 Headache
 Chills
 Upset stomach

7- Neoplastic disease : A neoplasm is an abnormal growth of cells, also known as a

tumor. Neoplastic diseases are conditions that cause tumor growth — both benign and
malignant. Benign tumors are noncancerous growths. They usually grow slowly and
can’t spread to other tissues. Malignant tumors are cancerous and can grow slowly or
quickly. Malignant tumors carry the risk of metastasis, or spreading to multiple tissues
and organs.

Symptoms of neoplastic disease greatly depend on where the neoplasm is

located. Regardless symptoms may be :

- anemia - shortness of breath

- abdominal pain -persistent fatigue
- loss of appetite -chills
- diarrhea -fever
- bloody stools -lesions
- skin masses
8- Munchausen Syndrome : is a factitious disorder, a mental disorder in which
a person repeatedly and deliberately acts as if he or she has a physical or mental
illness when he or she is not really sick. Munchausen syndrome is considered a
mental illness because it is associated with severe emotional difficulties.
Signs and symptoms of Munchausen's syndrome may include pretending to be ill
or self-harming to aggravate or induce illness.

There are four main ways people with Munchausen's syndrome fake or induce illnesses,
 lying about symptoms – for example, choosing symptoms that are difficult to disprove,
such as having a severe headache or pretending to have a seizure (fit) or to pass out
 tampering with test results – for example, heating a thermometer to suggest a fever or
adding blood to a urine sample
 self-infliction – for example, cutting or burning themselves, poisoning themselves with
drugs, or eating food contaminated with bacteria
 aggravating pre-existing conditions – for example, rubbing faeces into wounds to cause
an infection, or reopening previously healed wounds
Other signs
Some clues that a person may have Munchausen's syndrome include:
 making frequent visits to hospitals in different areas
 claiming to have a history of complex and serious medical conditions with no or little
supporting documentary evidence – people often claim they've spent a long time out of
the country
 having symptoms that don't correspond to test results
 having symptoms that get worse for no apparent reason
 having very good medical knowledge
 receiving few or no hospital visitors – many people with Munchausen's syndrome adopt
a solitary lifestyle and have little contact with friends or family
 being willing to undergo often painful or dangerous tests and procedures
 reporting symptoms that are vague and inconsistent, or reporting a pattern of symptoms
that are "textbook examples" of certain conditions
 telling highly unbelievable and often very elaborate stories about their past – such as
claiming to be a decorated war hero or that their parents are fantastically rich and

differentiations between odontogenic and non-odontogenic Pain:

-Odontogenic pain is generally derived from either one of two structures associated with the
tooth: pulpal or periodontal tissue.

-Pulpitis is the most common cause of odontogenic pain

- As a visceral organ, pain of the dental pulp is characterized by deep, dull, aching pain that may
be difficult to localize

- It may present as intermittent or continuous, moderate or severe, sharp or dull, localized or

diffuse and may be affected by the time of day or position of the body .- Periodontal pain is more
readily localized and identifiable because of proprioceptors located within the periodontal

- Therefore, periodontal pain will follow the characteristics of pain of musculoskeletal origin.

- The periodontal receptors are able to accurately localize the pain whether they are lateral or
apical to the tooth .
CLINICAL CHARACTERISTICS OF NON-ODONTOGENIC PAIN The clinical presentation of non-odontogenic
pain is varied and may mimic other pain disorders which may not originate in the orofacial region. The
extent of pain may vary from very mild and intermittent pain to severe, sharp, and continuous.
Furthermore, pains that are felt in the tooth do not always originate from dental structures, so it is
important to distinguish between site and source of pain to provide correct diagnosis and appropriate
treatments. The site of pain is where the pain is felt by the patient, whereas the source of pain is the
structure from which the pain actually originates. In ‘primary’ pain, the site and source of pain are
coincidental and in the same location. That is, pain occurs where damage to the structure has occurred.
Therapy for primary pain is obvious and does not pose a diagnostic dilemma for the clinician. Pain with
different sites and sources of pain, known as heterotopic pains, can be diagnostically challenging. Once
diagnosed, treatment should be posed at the source of pain, rather than the site. Neurologic
mechanisms of heterotopic pain is not well understood but it is thought to be related to central effects
of constant nociceptive input from deep structures such as muscles, joints and ligament [8]. Although
the terms heterotopic pain and referred pain are often used interchangeably, there are specific
distinctions between these terms. Heterotopic pain can be divided more specifically into

3 general types: a) central pain, b) projected pain, and c) referred pain

a)Central pain is simply pain derived from the central nervous system (CNS) resulting in pain perceived
peripherally. An example of central pain is an intracranial tumor as this will not usually cause pain in the
CNS because of the brain’s insensitivity to pain but rather it is felt peripherally.

B) Projected pain is pain felt in the peripheral distribution of the same nerve that mediated the primary
nociceptive input. An example of projected pain is pain felt in the dermatomal distribution in post-
herpetic neuralgia.

C)Referred pain is spontaneous heterotopic pain felt at a site of pain with separate innervation to the
primary source of pain. It is thought to be mediated by sensitization of interneurons located within the
CNS. Pain referred from the sternocleidomastoid muscle to the temporomandibular joint is an example
of referred pain [4]. The remainder of this article will focus on non-odontogenic pains of odontogenic

The cardinal warning symptoms of nonodontogenic toothache are as :

- spontaneous multiple toothaches
- inadequate local dental cause for the pain
- stimulating, burning, nonpulsatile toothaches
- constant, unremitting, nonvariable toothaches
- persistent, recurrent toothaches
- local anesthetic blocking of the offending tooth does not eliminate
the pain
- failure of the toothache to respond to reasonable dental therapy.

* The extent of pain may vary from very mild and intermittent pain to severe,
sharp, and continuous

- Pains that are felt in the tooth do not always originate from dental
- In ‘primary’ pain, the site and source of pain are coincidental and in
the same location
- Pain with different sites and sources of pain, known as heterotopic
pains, can be diagnostically challenging