Types of Pain – Referred (Read it to find out if you have it) – Part 1
Pain is a four letter in dentistry. We are not teeth treaters but we treat people. We are also called dental surgeons for a reason. Our training, and education, involves an understanding of anatomy of most of the body including the brain and its neuroanatomy. The bio-chemical interactions in the body have a bearing on our surgical treatments and how the body reacts to it.
Dentistry contains oral medicine, as the everything is connected. The mouth often is an early warning barometer of health issues. It is important to we are trained in recognising general medical issues such as diabetes, asthma, heart problems, anaphylaxis, medication interactions and so. Occasionally, medical emergencies arise, and need to be recognised.
Now to referred pain.
Referred pain can come from many sources:
Associated nerve branch
The nerves to the upper and lower teeth and jaw have a common nerve trunk going to the brain. It is called the trigeminal nerve. It is also known as the fifth cranial nerve. It has three main trunks. One trunk goes to each jaw and the third trunk ends around the eye. Pain in teeth if it becomes severe enough, can “travel”. The pain perception extends beyond the site of the culprit tooth to along the nerve on which supplies it. Generally, if a lower tooth nerve is inflamed greatly the pain is felt to travel to the ear. In the upper teeth the pain can go up the side of the face. However, if the intensifies then the pain is felt in the opposite jaw. In extreme situations the pain travels along the third trunk to be experienced around the eye. It is rare that the pain to cross to the opposite side of the face.
Nearby body structures
Sinus pain – is a common site of referring pain to the upper back teeth. The nerves for the upper back teeth lie in the floor of the maxillary sinuses. So, with inflammation of the sinus lining or build-up of pressure in the sinus can make these nerves fire.
If decongestants relieve the pressure in the sinus and the pain goes in the teeth then it’s probably sinus related. Teeth originated pain is not helped by these medications.
A further example of referred pain is the phenomena that pressure overrides pain. With sinus pain people often clench their teeth. The roots push up and apply pressure to the nerves entering the tooth from the lining of the sinus to reduce the pain. So, the clenching is muscle driven and loads the jaw joint. Presto! Muscle pain and jaw joint pain.
Lower Jaw/Teeth pain – tend to refer pain the jaw joint or the ear.
Upper Jaw/Teeth pain – tend to refer pain up the side of the face often it the temple area.
Just to complicate the situation, when the pain is severe enough it can be referred to the opposite jaw.
Nearby disease process
Occasional very inflamed ulcers can be often mistaken as tooth ache. Rarer conditions such cysts, tumours, and nerve diseases can also give rise to pain.
Brain perception
- Psychogenic pain is a pain disorder in the central nervous system (brain and spine) associated with psychological factors such as depression, anxiety, and post traumatic disorder. There is no physical cause and pain killers are ineffective.
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Next week
Types of Pain - Referred (Read it to find out if you have it) - Part 2