Referred dental pain – It hurts but where?

This is the fifth in a series of posts about orofacial pain with difficult to diagnosis or unusual origin.

1. Cracked tooth syndrome
2. Trigeminal neuralgia
3. Atypical odontalgia
4. Neuralgia-inducing cavitational osteonecrosis or NICO
5. Referred pain JADA Murray Sept 2009
6. Myofascial pain 
7. Burning Mouth Syndrome
8. Oral dysesthesia
9. First bite syndrome
10. Barodontalgia

Referred dental pain Etiology and Symptoms

This is pain “felt” in an area that it is not really coming from.  It is common in chronic muscle pain like TMD, fibromyalgia, and low back pain.  Usually a dull, deep aching pain that is hard to localize.  This occurs because of convergence of our nervous system, meaning multiple nerves run to the same area before heading to the brain.  So a pain in one area may fool the brain into thinking it is somewhere else.  For instance craniofacial pain can present as the only symptom of a heart attack (6% of time).

Pain coming from the muscle B could result in your brain thinking the pain is in a or c instead.

Common misdiagnosis of TMD when patient has cervical pain

Referred dental pain Treatment

Fortunately, the area of referred pain does give a hint as to where the actual pain is coming from.  The majority of the cases of referred pain come from a stressed or over-worked muscle.  Palpating the sore muscle will trigger the pain.  This used to be a link to ) an excellent article on how to palpate the muscles and where the referred pain tends to be for each muscle.  Finding the correct area of actual pain will lead to the correct treatment.  Sore muscles will require treatments similar to what is recommended in my acute TMD post.

This is one of the more common referred pain situations that patients seek dental care for thinking it is a tooth problem.

Wright JADA Sept 2000