Getting to the Bottom of Face, Mouth and Tooth Pain

You are experiencing pain in your mouth, which may also be radiating into the rest of your face. Is it a toothache, or is your pain being caused by something else? There could be a problem that seems like a toothache, but is actually coming from someplace else in your jaw, neck or face. It could be something as simple as a tooth that needs treating, or it could be a combination of causes. Let’s look at some of the likely scenarios.

Past Dental Treatment:

A significant source of pain is associated with past dental treatments including root canal therapy, surgical procedures and implant placement. When these procedures are done and the pain does not go away, it is because the pain has been changed to neuropathic pain and cannot be reversed by additional dental procedures.
There are ways to reverse the pain.

Where is the pain coming from?

Sometimes people have pain in the area of the face, head and neck and no one can figure out precisely where it is coming from. If the pain seems to involve the teeth, often unnecessary dental procedures are done and the pain remains. Here are some examples of what we find.

Muscle Trigger point pain:

When a muscle of the head or neck develops a trigger point within the muscle, it can be a source of pain which is felt elsewhere. I see patients who complain of vague continuous pain which may seem to be coming from a tooth. The muscle exam of the face and neck, which we routinely do, enables me to locate the trigger point by pressing on it. When this is done, the pain can be replicated elsewhere. Sometimes a trigger point can produce a severe lasting pain which is described as a deep ache, not affecting a tooth or teeth.

Pretrigeminal Neuralgia:

This type of pain can last for several hours and then come back again later in the day. Often there will be a remission period for a couple of days and then the pain will come back again. Sometimes this pain is called Atypical Neuralgia, and is the likely precursor for Trigeminal Neuralgia. It lasts for long periods of time and is described as a burning pain.

Atypical Odontalgia:

This type of pain is most always associated with a previously-treated tooth. The patient has a history of continuous pain which is more than 4 months old. Often this patient’s pain seems to be coming from an area where some dental procedure has been done, including an extraction or even a minor dental procedure. This kind of pain afflicts mostly women in their fourth decade of life. It is often described as wave-like, varying from moderate to severe in intensity. The quality of this pain is described as a constant burning.

Deafferentation Pain:

After a traumatic injury of the face, head or neck, including soft tissue lacerations, some patients fail to heal normally. Some of the nerves injures caused by the trauma never develop normal healing. At peripheral sites, where there is this kind of healing failure, the nerves at the injury site will fire off pain signals though there was no trauma present to induce the firing. Real pain is felt by the patient. If these pain firings last for a long time, such firings are eventually replicated a higher level in the brain. We then describe the pain as being centrally located and it evolves into long term chronic pain.

Burning Mouth Syndrome:

Burning mouth syndrome is often age-related, affecting women after menopause. The front part of the tongue burns and may involve the lips and palate. It tends to get worse as the day continues. It is often associated with phantom tastes, such as a metallic taste. Some aspects of taste may be missing. A similar condition, burning mouth symptoms, is a condition that may have multiple causalities including an oral Candida or viral infections; past dental treatments that have odd healing outcomes and secondary manifestations of a systemic condition.

Tigeminal Neuralgia:

“Electric shock” pains can occur multiple times a day and is often associated with a trigger area. Talking, smiling, eating and even light touch may initiate this neuropathic pain disorder.

At our practice, we believe no pain needs to be, or should be, tolerated – it’s important to find out why you’re hurting, and get to the bottom of your pain.  Dr. Markman provides you with complete diagnosis and treatment of your face, mouth and tooth pain.