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Orofacial Pain: How to Differentiate Pain from Toothache

orofacial pain
Dr.Nisha George
Dr.Nisha George
September10/ 2015

Pain is the most unpleasant feeling one can have .Orofacial pain is characterized by sharp, throbbing or burning pain in the head, neck, face, mouth, gums or teeth. Many times we neglect facial pain without knowing the underlying problems. If you are aware how to differentiate the pain, it would help you to seek the treatment faster.

Cardiac toothache
  • Angina pectoris or acute myocardial infarction, referred pain to the shoulder, arms, jaws and to the teeth.
  • Associated with chest pain occasionally.
  • Tooth pain increases with the exercise and decreases with nitroglycerin (medicine to heart)


Treatment is directed to the underlying heart problem after the dental evaluation.
Sinus Toothache
  • Several upper teeth, dull pain, aching or throbbing.
  • Associated with pressure below the eyes and it worsens by bending down, applying pressure in the sinuses, coughing, sneezing.
  • Chewing, cold, percussion, worsen the pain. History of upper respiratory infection,  nasal congestion, or sinus problem
Local nerve block will block the tooth pain.Antibiotics should be given for the sinus problems.
Salivary Gland Dysfunction
  • Associated teeth pain with salivary gland dysfunction.
  • Absence of saliva.
Comprehensive evaluation of the salivary glands is needed
Myofascial pain
  • Dull pain over the muscles, tendon or fascia.
  • Localized tenderness over the firm bands of muscle. Associated dental hypersensitivity.
Trigger point injection.
Masticatory muscle disorders
  • Pain especially during chewing, opening of the mouth.
  • Tenderness on palpation.
  • Limited range of motion due to pain.
  • Feeling of muscle weakness.
Treatment: Eliminate etiology factors.Trigger points injections, using Marcaine 0.5% w/o Kenalog.Restrict mandibular function „ Simple muscle relaxation therapy.„

Medication(anti -inflammatory, muscle relaxant)

Physical therapy

Dental and oral diseases
  • Pain mostly acute and unilateral related to the tooth and surrounding structures.
  • Diseases  of the oral mucosa would be painful and is associated with a lesion (eg: mouth ulcers, herpes zoster etc)
Treatment done accordingly after the dental evaluation.
Temperomandibular disorders, TMD
  • Moderate to severe facial pain of a throbbing quality, lasting hours, precipitated by chewing and difficulty in opening and closing the mouth.
  • Clicking noise
Diet, physical therapy, NSAIDS, splints, surgical.
  • Moderate to severe facial pain of a throbbing quality, lasting hours or days, occurs episodically several times per year, mostly unilateral, associated with sensitivity to light, nausea, vomiting.
Analgesics, Triptans, Ergotamines.Changing the life style.
Cracked tooth
  • Sharp, brief facial pain lasting seconds to minutes, precipitated by chewing, possibly with release of biting pressure, or pain when your tooth is exposed to temperature extremes.
Endodontic procedures depending on the type of fracture.
Trigeminal neuralgia
  • Sharp, shooting facial pain lasting seconds to minutes, precipitated by chewing, light facial stimulus or of spontaneous onset.
  • Usually unilateral episodic pain.
Carbamazepine.Microvascular decompression.
Glossopharyngeal neuralgia
  • Pain can be experienced in ear only, so confused with TMD. May also be confined with the posterior part of the tongue.
Same as Trigeminal neuralgia.
Burning mouth syndrome
  • Pain in the mouth that is burning, scalding or tingling. Mostly in the tongue. Lips and roof of the mouth is affected. Lasts for months or years.
Pain relief medications. Evaluation for underlying problems.

Having a good knowledge and awareness can help you take a good decision for a better diagnosis and a treatment plan. It is never too late to visit a dentist or a medical practitioner to seek help.

Dr.Nisha George
Dr.Nisha George

Dr. Nisha George completed her graduate degree in dentistry from Bangalore, following which she completed her PG diploma in hospital administration from Apollo. She is currently pursuing her Masters in oral biology research from Rutgers University in USA.

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