Abstract
Due to the unique sensory innervation of the teeth and face, orofacial pain can be challenging to diagnose and manage. Odontogenic pain, or ‘toothache’, is the most common orofacial pain condition and encompasses the vast majority of pain which is presented to dental practitioners. While diagnosis is often straightforward, the clinical picture is occasionally unclear or contradictory, and in these situations, the clinician should be able to consider reasons other than the teeth for the patient’s presenting complaint. The primary aim of managing odontogenic pain is to treat the underlying cause, often arising from the dental pulp or periapical tissues; however, several factors can make pre-, intra- and post-operative management of odontogenic pain challenging. This paper will consider key similarities and differences in the clinical presentation of odontogenic pain and other non-odontogenic causes of orofacial pain in order to help practitioners arrive at the correct diagnosis. We discuss evidence-based recommendations for intra- and post-operative management of acute odontogenic pain, and consider the underlying neurophysiological features which make orofacial pain challenging to manage.
Key points
- Orofacial pain is unique and often difficult to diagnose due to mechanisms such as peripheral and central sensitisation, presenting a diagnostic challenge.
- Other painful conditions (eg TMD) can increase the severity of, or even masquerade as, odontogenic pain.
- Effective pain management may involve systemic approaches combined with local measures to enable effective treatment and reduce the risk of post-operative pain.