The most common cause of intraoral pain in patients presenting to dentists is odontogenic and rarely presents a diagnostic challenge. However, pain in the oral cavity that is not dental or periodontal in origin may be difficult to diagnose and treat.
Neuropathic pain in the orofacial region, such as post-herpetic neuralgia, post-traumatic painful peripheral neuropathy ('phantom tooth pain'), idiopathic trigeminal neuralgia (tic douloureux), or chronic orofacial pain ('atypical odontalgia') can be defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system. The presentation of neuropathic pain in and around the mouth has been extensively reviewed.123
If neuropathic pain is suspected a thorough clinical evaluation is necessary to assess this type of pain and its mechanism. Dental treatments that are irreversible and potentially harmful to the underlying dentoalveolar structures must be avoided when the diagnosis is uncertain.
Dentists are often asked to exclude the likelihood of pain of odontogenic origin contributing to neuropathic pain. They need to be aware of the drugs patients may be taking as well as making themselves available to assist in the management of these patients within multidisciplinary pain clinics.
- Bennett GJ. Neuropathic pain in the orofacial region: clinical and research challenges. J Orofac Pain 2004;18:281-6.
- Merrill RL. Intraoral neuropathy. Curr Pain Headache Rep 2004;8:341-6.
- Vickers ER, Cousins MJ. Neuropathic orofacial pain. Part 1 - Prevalence and pathophysiology. Part 2 - Diagnostic procedures, treatment guidelines and case reports. Aust Endod J 2000;26:19-26 and 53-63.