Abstract
Toothache is almost always caused by odontogenic toothache, but diagnosis is more difficult in the case of nonodontogenic toothache. We report a case of simultaneous occurrence of odontogenic and nonodontogenic toothache. This manuscript presents a case report for a 35-year-old woman who visited our Orofacial and Head Pain Clinic with the chief complaint of continuous dull pain in left maxillary molar teeth region. It was concluded to be a case of simultaneous odontogenic toothache and nonodontogenic toothache. It was successfully treated by an endodontist and an orofacial pain specialist. The endodontist performed root canal treatment against odontogenic toothache caused by apical periodontitis using a dental operating microscope. The presence of a trigger point (TP) resulting in tooth pain was inferred. A trigger point injection (TPI) was administered by orofacial pain specialist, and toothache relief was confirmed. Myofascial pain was diagnosed definitively. After confirming that the toothache had resolved at multiple TPIs, a crown prosthesis was placed. Following the application of crown prosthesis, we were concerned but did not find recurrence of toothache from myofascial pain due to increased occlusal force. This case suggests that there is no single cause of chronic pain and that multiple causes must be considered for diagnosis, suggesting the need for treatment by multiple specialists.
Highlights
Toothache, the most common type of orofacial pain, is often attributable to dental pulp or periodontal tissue
Toothache is almost always caused by odontogenic toothache, but diagnosis is more difficult in the case of nonodontogenic toothache
We report a case of simultaneous occurrence of odontogenic and nonodontogenic toothache
Summary
The most common type of orofacial pain, is often attributable to dental pulp or periodontal tissue. Since patients complaining of oral pain present with various symptoms, clinicians encounter cases in which making an accurate diagnosis is difficult [1]. A diagnosis can be especially difficult in cases in which patients present with symptoms of nonodontogenic toothache similar to odontogenic toothache [2], and even more difficult in cases involving referred pain. Myofascial pain referred to tooth (MPRT) in the masseter muscle, one cause of nonodontogenic toothache, is observed in 11% of patients with myofascial pain [3]. Nonodontogenic toothache can occur together with odontogenic toothache [4] [5] Such cases are even more difficult to diagnose due to the multiple causes of the pain. We report a case of successful treatment of a residual pulp in a calcified root canal by an endodontist with root canal treatment using a microscope and combined treatment with trigger point injection (TPI) by an orofacial pain specialist
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