Presenting with Pain without obvious Signs and Symptoms
Presenting with pain without obvious signs and symptoms
General Principles of orofacial pain of unknown origin
Diagnostic tools
General principles of orofacial pain of unknown origin
With any facial pain the general principle is to eliminate any dental / oral pathology as a cause. People often present with referred pain to the ear or temporal area which is dental / oral in origin or from the upper to lower jaw and vice versa. Pain of odontogenic origin is not referred across the midline so look for a cause on the same side of the face from where the pain is originating. Sometimes patients may end up having brain scans done to eliminate pathology in this region when the cause is of a much more common origin.
Diagnostic tools
- The orthopantomogram is an invaluable diagnostic radiographic tool to evaluate pathology relating to the teeth or surrounding alveolar bone and related anatomical structures such as the maxillary sinuses, nasal cavities and tempero-mandibular joints. This does however, require interpretation by a dentist or a maxillo-facial and oral surgeon (MFOS).
- Cone Beam Dental Scan is 3D scanning technology which provides detailed three dimensional images of the jaws.
- Administering local anaesthesia by infiltration technique opposite a suspected tooth which might be the cause of pain can not only provide pain relief for a patient but also provide irrefutable proof as to the cause of the pain.
References:
Douglass AB & Douglass JM (2003). Am Fam Physician. Common dental emergencies. Feb 1; 67(3):511-517.
Parthiscar A & Har-El G (2001). The annals of Otology, Rhinology and Laryngology. Deep neck abscess: a retrospective review of 210 cases. 110(11):1051-1054.
Fundamentals of Paediatric Dentistry (3rd Edition). RJ Mathewson, RE Primosch. Pg 287 + 297+ 301.
Dentistry for the child and adolescent (6th Edition). RE McDonald, DR Avery. Pg 503—563.
The management of traumatised anterior teeth of children. JA Hargreaves, JW Craig, HL Needleman.
Flores MT, Andersson L, Andreasen JO et al. (2007). Guidelines for the management of traumatic dental injuries II (b). Avulsion of permanent teeth. Dental Traumatology 23: 130-- 136.
Flores MT, Malmgren B, Andersson L, et al. (2007). Guidelines for the management of traumatic dental injuries III (c). Primary teeth. Dental Traumatology 23: 196-- 202.
McIntyre JD, Lee JY, Trope M, Vann WF (2007). Management of avulsed permanent incisors: a comprehensive update. Paediatric Dentistry 29 (1): 56—63.