Diagnosis of Odontalgia

• Published in: Shika Hoshasen Vol. 45; no. 1; pp. 5 - 9
• Main Author: SASANO, Takashi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Oral and Maxillofacial Radiology 2005; 特定非営利活動法人 日本歯科放射線学会
• Subjects: Neurogenic inflammation; Odontalgia; Trigeminal nerve; 三叉神経; 歯痛; 神経原性炎症
• ISSN: 0389-9705; 2185-6311
• DOI: 10.11242/dentalradiology1960.45.5

We encounter many patients who complain of odontalgia in the daily dental treatment. However, it is sometimes difficult to find the origin of the pain, since the pain sensation located in pulpal or periodontal tissues may be caused by not only pulpal or periodontal diseases but other origins (e. g., jaw bone disease, paranasal sinus disease, oral mucosal disease, neural disease, psychologic disease or systemic disease). These diseases relate to odontalgia, and vice versa. Further more, pulpal or periodontal pain is not well localized. Our clinical study on related pain has shown that 1) localization in posterior teeth is poor compared to that in anterior teeth for both pulpal and periodontal sensation, 2) mis-localization generally occurs in teeth proximal to the stimulated teeth, 3) pulpal sensation is sometimes mis-localized to a tooth in the contralateral jaw. Diagnosis of odontalgia has been clinically undertaken by three approaches, i. e., interview, clinical findings and radiographic findings. It should be noted that a careful interview promotes a correct diagnosis. Our data, in this respect, have shown that more than eighty% of odontalgia can be diagnosed by interview alone. Recent neuroscience study has shown that antidromical stimulation of the sensory nerve evokes vasodilatation and extravasation at the site of innervations, in short, pain promotes neurogenic inflammation. Particularly in the pulpal and periodontal tissues, severe vasodilatation is induced because of their low compliance system, and the induced vasodilatation evokes secondary pain in these enclosed tissues. Consequently, determining the origin of odontalgia and immediate treatment of the pain should be most important.