CASE REPORT OF A PATIENT WITH A
TOOTHACHE OF NONDENTAL ORIGIN

When a patient experiences a toothache of nondental origin such as TMD-related toothache, migraine-related toothache, trigeminal neuralgia, atypical odontalgia, or neuroma/posttraumatic neuralgia the patient feels the pain exactly as if it were a true toothache. Although there are numerous case histories that can describe each type of toothache of nondental origin the following case report is presented because it portrays a common scenario.

Mrs. Smith presented to her dentist with a toothache of three weeks duration. The dentist examined the tooth and gums, read an X-ray of the tooth, but could not find a reason for the pain. He suggested that Mrs. Smith go home and return another day if the pain did not go away, or if it felt worse.

Two weeks later, Mrs. Smith returned to her dentist who performed the same diagnostic tests and once again there were no finding. However, this time, because Mrs. Smith continued to experience pain and it was becoming more intense, her dentist felt the need to help Mrs. Smith and he performed a root canal.

Curiously, while the root canal was being done, even though the dentist gave Mrs. Smith five doses of anesthetic she still felt pain during the procedure. That night the pain was even worse when the anesthetic wore off. First she thought it must be normal to have a lot of pain after a root canal but the next day when the pain kept on getting worse she had to see her dentist again as an emergency patient. The dentist examined the tooth, took a new X-ray, and having found nothing unusual he prescribed an antibiotic and told Mrs. Smith to call him again if the pain got worse.

Two days later the pain was getting very severe so she spoke to her dentist, this time on the phone, and he suggested she consult with an endodontist. The endodontist could find nothing wrong so he changed the antibiotic, prescribed strong pain medicine, and told Mrs. Smith to return the following week.

Although Mrs. Smith was in severe pain that week despite taking the antibiotic and pain medicine she waited until her next visit. Once again the endodontist could find nothing wrong and so he referred her to an oral surgeon. The oral surgeon requested that Mrs. Smith wait two weeks to see if the pain would go away with time. Two weeks later Mrs. Smith saw the oral surgeon on an emergency visit became the pain was unbearable and so the surgeon consulted with the dentist and endodontist and all agreed that the root canal treatment probably didn’t work and so the surgeon performed a surgical apicoectomy to clean and seal the apex of the tooth.

Once again during the apicoectomy Mrs. Smith felt excruciating pain even though the surgeon gave her two kinds of anesthetic. Worse, the pain didn’t go away. It became horrific and she found sleep to be impossible. She returned to the oral surgeon two days later and the surgeon concluded the root canal and apicoectomy failed and it would be best to extract the tooth. The tooth was extracted that day. After one month despite the fact the tooth was extracted there was still terrible pain, just as if the tooth were still there.

Mrs. Smith consulted with her dentist, endodontist, and oral surgeon three months later and they all concluded, including Mrs. Smith, that another tooth must be the reason for the pain. Consequently, the tooth adjacent to the extraction site was treated with a root canal and once again the pain persisted.

After seeing several other dentists, her physician, and a neurologist Mrs. Smith eventually consulted with an orofacial pain dentist who diagnosed a toothache of nondental origin. He explained that although she felt severe pain in the tooth and later in the extraction site the pain never did come from the tooth and that was the reason dental treatment failed. Eventually the correct diagnosis was made and effective treatment followed.

What is a toothache of nondental origin? | Example of a patient with toothache of nondental origin
Do I have a toothache of nondental origin?

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