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<p>Differential diagnosis of non-odontogenic pain in the oral cavity<br>Colonel Michael J. Apicella, DC, USA; Captain John F. Johnson, DC, USN<br><br>Introduction<br>A survey of 42,370 adults in the United States showed that 9,072 individuals (21%) had experienced orofacial pain more than once in the last 6 months. While 12.2% of the respondents had pain of odontogenic origin, almost 7% had pain involving the TMJ and other orofacial structures. Another study found that nearly one third of patients referred to a tertiary pain center for chronic orofacial pain had undergone prior surgical procedures to address their symptoms. The procedures consisted of endodontics (30%), extractions (27%), apicoectomies (12%), TMJ surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Many of the patients actually felt their pain was worse following the surgical interventions. The majority of the patients were diagnosed by the pain center as experiencing either muscle-related pain (50%) or atypical facial pain (40%). Both of these studies suggest there are a substantial number of patients who may present to the dentist with orofacial pain complaints of non-odontogenic origin and with conditions that are unresponsive to surgical procedures.<br><br>Establishing the correct diagnosis is essential before rendering treatment. Well-intentioned therapy for the wrong diagnosis can be ineffective and may exacerbate the existing condition. When evaluating a pain complaint, it is essential for the dentist to be knowledgeable of odontogenic sources of pain as well as other structures or conditions with the potential to refer pain to the orofacial region. Non-odontogenic orofacial pain is frequently of musculoskeletal, neurovascular, neuropathic or vascular origin.
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<br>Subjects: Dental Care; Dentists; Diagnosis; Differential;  Endodontics;  Facial Pain</div>
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U.S. Navy. Naval Postgraduate Dental School</div>
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