ORAL PATHOLOGY 1

Fa c i al
p a i n
DMD 3
SECTION A

Angel Nicole H. Garcia

 CLASSIFICATIONS OF PAIN
Nociceptive Pain 
It is a medical term used to describe the pain from physical damage or potential damage to the body. Examples might be the pain felt from a
sports injury, a dental procedure, or arthritis. Nociceptive pain is the most common type of pain people experience.
Neuropathic Pain
It is the pain caused by damage or disease affecting the somatosensory nervous system. Neuropathic pain may be associated with abnormal
sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal)
components.
Acute Pain
It  is a type of pain that typically lasts less than 3 to 6 months, or pain that is directly related to soft tissue damage such as a sprained ankle or
a paper cut. Acute pain is of short duration, but it gradually resolves as the injured tissues heal.
Chronic Pain 
It is pain that is ongoing and usually lasts longer than six months. This type of pain can continue even after the injury or illness that caused it
has healed or gone away. Pain signals remain active in the nervous system for weeks, months or years.
Radicular pain
It is a type of pain that radiates from your back and hip into your legs through the spine. The pain travels along the spinal nerve root. The
leg pain can be accompanied by numbness, tingling, and muscle weakness. Radicular pain occurs when the spinal nerve gets compressed
(pinched) or inflamed.

Common source of pain, found in the head and neck region:

Poor posture, repetitive movements, and strains may all cause neck pain. The most common cause of neck pain is a muscle strain, in which a
muscle is stretched too far and tears. Neck muscle strain is typically caused by poor posture or support, such as sleeping with the neck in
awkward positions.
Odontogenic Origin:
Dentin hypersensitivity is a result of exposed dentin. The reproducible symptoms are sharp, fleeting, intense pain to chemical,
thermal, and tactile stimuli.
Reversible pulpitis occurs when a localized irritant such as caries or microleakage cause toothache symptoms.
Irreversible pulpitis is characterized by lingering pain to thermal stimuli often accompanied with spontaneous pain. Percussion,
biting, and/or palpation sensitivity are also common, indicating inflammation in the peri radicular tissues. The radiograph will
frequently show widening of the periodontal ligament.
Dental caries that extends into the dentin or pulp can be stimulated by anything—hot, cold, biting, percussion, palpation, and sweet
or acidic foods. Radiographic and clinical examination will confirm this diagnosis.
Pulp necrosis has 2 distinct presentations. The first is characterized by spontaneous throbbing pain and no response to thermal
stimuli and electric pulp tests.
Non-odontogenic Origin:
Myofascial pain
The myofascial pain is described as non-pulsatile and aching pain associated with muscle. Patients are unable to locate the
source of the pain and believe that the pain is associated with the tooth.
Cardiac Toothache
Cardiac ischemia is a source of pain to the jaw associated with referred pain to the left shoulder, arm, neck, throat, ear, teeth, and
mandible.
Sinus Toothache
Sinusitis is due to the approximation of the roots of maxillary posterior teeth to the sinus cavity, infection in the dental tissue can
lead to sinus inflammation and infection. Any infection and inflammation in the maxillary sinus can also present as odontogenic
pain.
Neurovascular Toothache
Headaches are most commonly associated with the cranium, however, sometimes may involve the orofacial region thus mistaken
as odontogenic pain.
Psychological stress
This may lead to development of psychogenic tooth ache. Pain may be described as diffused, vague, and non-localized or sharp,
stabbing, intense, with sensitivity to temperature changes.

DIAGNOSTIC OPTIONS
Odontogenic
In order to differentiate odontogenic pain from other facial pain, a multidisciplinary evaluation must be performed. Classic tests to help
differentiate odontogenic from nonodontogenic pain include thermal, electric pulp tests, percussion, palpation, biting, and transillumination.
Non-odontogenic
Nonodontogenic toothaches need to aid correct diagnosis, precise understanding of clinical characteristics of odontogenic and
nonodontogenic toothache, careful history, clinical and radiologic examination, and thorough evaluation of the nature of the pain are
recommend.
 ODONTOGENIC
Dentin hypersensitivity
Clinical Features: dentinal hypersensitivity is defined as a short, sharp pain arising from exposed dentin in
response to stimuli. The distress caused by hypersensitivity can range from minor to severe.
Radiological Features: The essential characteristics for appearance of dentin hypersensitivity are presence of
exposed dentin surfaces, open tubule orifices on the exposed dentin surface and open tubules leading to a vital
pulp.
Reversible Pulpitis
Clinical Features: Reversible pulpitis refers to instances where the inflammation is mild, and the tooth pulp
remains healthy enough to save. Irreversible pulpitis occurs when inflammation and other symptoms, such as
pain, are severe, and the pulp cannot be saved.
Radiographical Features: Reversible pulpitis will not show periapical lesions radiographically but may show
thickening of the periodontal ligament (PDL), loss of lamina dura, and/or condensing osteitis.
Irreversible Pulpitis
Clinical Features: The patient may experience intense, lingering pain to temperature changes, spontaneous
pain, diffuse or referred pain.
Radiographic Features:  Irreversible pulpitis may show widened PDL space.
Dental Caries
Clinical Features: Patient may experience toothache, spontaneous pain or pain that occurs without any
apparent cause, tooth sensitivity, mild to sharp pain when eating or drinking something sweet, hot or cold,
visible holes or pits in your teeth, brown, black or white staining on any surface of a tooth, pain when you bite
down.
Radiological Features: The carious process results in demineralization, which is radiolucent, because the
carious lesion attenuates the beam less than healthy tooth structure.
Pulp Necrosis
Clinical Features: The most common symptoms of damaged pulp include pain in your tooth and swelling and a
sensation of heat in your gums.
Radiological Features: The tooth with a pulp necrosis showed a tendency that led to radiolucency on
periapical radiograph histogram.

DIAGNOSTIC OPTIONS
Pharmacologic
Odontogenic
Antimicrobial treatment includes the use of beta lactams, macrolides, tetracyclines, metronidazole, clindamycin, or
combined treatment. The most commonly used ones are administered orally. Amoxicillin/ clavulanic acid is one of the
antibiotics recommended for the treatment of odontogenic infections due to its wide spectrum, low incidence of
resistance, pharmacokinetic profile, tolerance, and dosage.
Non-odontogenic
The first-line treatment of erysipelas is intravenous benzyl-penicillin. In penicillin allergic patients, clindamycin may be used.
Anti-staphylococcal drugs are considered if patients fail to improve or have features suggestive of staphylococcal infection
like bullous eruptions.

Surgical or Non-surgical Treatment

Odontogenic
 The surgical goals in head and neck infections are to secure the airway, to establish dependent drainage, and to remove
the cause of infection. Incision and drainage decrease the bacterial load the immune system must face by physically
removing pus. Intraoral incisions are generally made in the oral vestibule at the point of maximum swelling.

Non-odontogenic Origin:
Treatment generally requires surgical debridement of gangrenous skin, incision and drainage of the underlying tissue and
fascial planes