- Dr Sonal Yerpude
Abstract
Orofacial pain is one of the key considerations for diagnosis in routine dentistry. We all are familiar with patients demonstrating referred pain in our practice. The pain can be referred from a tooth or muscle or any other site from the body to an area which shows no clinical or investigative findings. Such situations are tricky to diagnose and a thorough investigation is the key to success for such cases. The article demonstrates a case report under the guidance of Dr. Davis Thomas. When a patient comes with pain around certain teeth but clinical or radiographic findings are contradictory to the patients chief complaint, ‘diagnostic blocks’ act as a very simple yet effective way for diagnosis of site or the source of pain .
Introduction
To be able to differentiate between the site and source of the pain should be one of the key criteria for diagnosis. Site of pain is the spot or area where the pain is felt, it may or may not be the place where the pain originates. It is easily pointed out by the patient. Source of pain is the spot from where nociceptive input of the pain originates. For a good clinician to be able to achieve correct diagnosis and treatment plan, the source of pain has to be identified.
When the site and source of pain is the same, diagnosis and treatment is easy. But when they differ, like in cases if referred pain, diagnosis and treatment can be extremely tricky, time consuming and challenging.
A very useful and effective technique for the diagnosis in such situation would be diagnostic blocks. An anaesthetic block at the site of pain will immediately cut or cease the painful stimulus and the pain will stop in case of primary pain. In case of referred pain, the anaesthetic agent will not cease the pain at the site of pain.
Case report
A 24 year old Indian married working lady reported with sharp shooting pain in upper right premolar region since two weeks. Pain aggravated on chewing food and while talking. Intensity of pain was more profound in evening and patient self medicated herself with NSAID’s which reduced the pain intensity in 10-20 min for 10-12 hours .
When the patient walked in to the practice, she had throbbing pain for the past 2 hours .
On intraoral and radiographic examination, there was no cause of pain to be actually originating from the premolar region .
With patients consent, 1.2 ml 2% lignocaine hydrochloride was injected in the buccal and palatal area of pain site. As was expected, the anaesthetic agent did not cease the pain at all.
We recalled the patient when she is symptomless. On provocation of middle temporalis muscle, patient gave very positive replication of pain with same intensity and temporal pattern, as it acted as trigger.
Differential diagnosis for this case -
- Pain referred from other teeth (odontogenic)
- Pain due to trauma to some muscle or ligament
- Sinus congestion
- Systemic involvement
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