When Mouth Pain is Not Dental Pain

It makes sense that whenever someone has pain in their mouth or in their face, that they first vist their friendly, neighborhood dentist. Jaw pain is usually from an infected tooth, or a gum problem or even a problem with the jaw joint (the TMJ) or the muscles used for chewing. Often, the dentist will diagnose the reason for the pain and treat it within an hour. However, there are some very interesting causes of oral-facial pain that dentists should consider. Some are more common. Some are quite unusual. Some diagnoses herald chronic disease. Some diagnoses demand a quick trip to the hospital emergency room. Usually, these conditions are more difficult to diagnose and treat successfully than patients expect.

Dentists are aware that jaw pain, a dull unrelenting ache, especially in the lower left side of the mouth is a possible sign of heart pain from a heart attack. It is important for the dentist to rapidly rule out a dental cause, and suggest the correct diagnosis. When the dentist suspects jaw pain may represent pain referred from the heart, do not insist on driving to the nearest hospital emergency room. It might be best to wait for an ambulance.

Sinus pain often masquerades as dental pain. This kind of pain begins as a dull ache and may become sharp. Patients will say that they are not sure which tooth is the one that hurts. Dentists will ask questions and will find that the pain feels different when sitting, standing, or reclining. Pain of dental origin does not usually change that much based on position. Many of these patients will have a history of sinus headaches, runny noses, and allergies. Usually, sinus pain occurs on one side only. The dentist will percuss or tap on several teeth with the handle of the mouth mirror and will find that two, three or more upper teeth respond. Tapping on the cheek bone may cause more pain. The dentist will refer a patient with sinus pain to their physician to treated for sinusitis (inflammation of the lining of the sinuses).

Occasionally, patients present with severe pain that begins in response to mild stimulation such as a touch to the face or a gentle breeze. This pain may progress to unrelenting severe pain. Trigeminal neuralgia or tic douloureux refers to a condition that effects the trigeminal nerve, a nerve that provides feeling to the skin of the face, the teeth, the eyes and the lining of the mouth. This pain may be due to aging, disease such as multiple sclerosis, or a tumor that presses on the nerve. Treatments range from oral and injectable medications to surgery. This is not a common condition, so many dentists may not recognize it. The general dentist is likely to refer a patient with this condition to an Endodontist (root canal specialist) or an Oral Surgeon to make the diagnosis and prescribe treatment.

Sjögren's syndrome is an auto immune disease similar to rheumatoid arthritis and lupus erythematosis. Commonly, Sjögren's will cause dry mouth (xerostomia) and dry eye (xero-opthalmia, or keratoconjunctivitis sicca). Less commonly, Sjögren's may cause neural pain including, but not limited to, trigeminal neuralgia. The diagnosis of this condition rests in the dentist recognizing the combination of dry eye and mouth, and noticing that the salivary glands are swollen. Further testing will include blood tests and may include a biopsy of the lining of the lower lip to discover damage to small salivary glands. Treatment of trigeminal neuralgia from Sjögren's is the same as from other causes.

Temporal arteritis is an inflammation of one or more major arteries in the face or scalp. This condition may present initially as oral pain, muscle tenderness, and scalp pain. When this condition affects the artery that supplies blood to the retina, the patient will loose some or all of their vision in one or both eyes. Temporal arteritis is much more common in advanced age than in youth. Blood tests and biopsy of the suspect artery (removing a piece to examine under a microscope) confirm the diagnosis. Large doses of steroids such as prednisone often cure this condition.

Burning tongue or burning mouth syndrome is self describing. Patients will arrive at the dental office in distress with mild to severe discomfort. The cause of burning mouth or tongue may be obvious or simple. The dentist should be able to diagnose and treat a fungal infection or poor fitting dentures. Other causes include medical conditions such as diabetes, hypothyroidism, and menopause. The blood pressure lowering ACE inhibitor medications and others may cause this burning sensation. However, the cause may not be found; medicine refers to this as primary or idiopathic burning mouth syndrome.

Patients who present to their dentist with pain expect relief quickly. Quick, effective treatment is the norm. Unfortunately, there are many cases of pain that are difficult to diagnose and hard to treat. If you have oral or facial pain, see your dentist immediately. If relief is not immediate, discuss the situation with your dentist. You may be suffering with a condition that will take more time and effort to diagnose than a common tooth ache.