Facial Pain: Not all is Tooth Related

It’s important for a practicing dentist to be aware of oddball conditions, that my be dental related, but in fact, have no dental etiology at all.   This point was brought home to me through a course I took on facial pain that was quite disturbing.   Over a 7-8 year period, one patient’s history describes pain on a lower second molar, for which a root canal was performed.  When that didn’t handle the pain the tooth was extracted. A short time later, the same thing happened to the tooth in front of it, then the one in front of that one.  Further investigation, which included extensive tests, revealed a major problem in the brain that was responsible for this pain, and the dental treatments were apparently unneeded.

Another patient of mine had severe pain on his lower right. He had previously had a crown done on a lower canine tooth for a fracture, but that did not remedy the situation. He was treated with a painful surgery for a calcified ligament in his neck which can cause some pain (Eagle’s Syndrome), but once again, no luck. He even saw a dental pain specialist who was going to do some extensive work on his bite. Eventually he made it to an oral surgeon who took a complete medical history, paying attention to the fact that this patient had lost his hearing on that side about 10 years or so prior to the painful episodes that he was experiencing. A brain scan at a neurologist showed a benign brain tumor that was responsible for the deafness, and the increasing size was pressing on the next cranial nerve and causing terrible pain.

Another of my patients has trigeminal neuralgia, a debilitatingly painful condition to the face. There are different treatments for this, starting with medications and encompassing brain surgery to relieve the intense pain.

Armed with this knowledge the dentist can refer the patient to someone with more knowledge of these rare conditions who can provide successful treatment earlier rather than later, without a lot of run around. I have a favorite periodontist and oral surgeon who takes my referrals and that works well. I do appreciate these exceptional clinicians who can provide great service to my patients when needed.