Unclear Diagnosis

You have been referred to an endodontist because you are having pain/discomfort/sensitivity or achiness in your head and neck region, more specifically somewhere in your mouth. An endodontist is a dental specialist that deals with the diagnosis and treatment of odontogenic (tooth related) and non-odontogenic pain.

Not all pain that people experience is necessarily tooth related, however statistics show that approximately 90% of head and neck pain can be traced back to the teeth. The remaining 10% is non-odontogenic, that is not tooth related.

Of the 90% or so of cases that cause head and neck pain, and can be reliably traced to a tooth, conservative approaches can be recommended. These include placing a filling after the removal of dental caries, (decay), replacing a worn, cracked or leaky filling, placement of a soothing pulp friendly sedative temporary filling, or even the placement of a crown or cap to protect a weak heavily stressed tooth and minimize the likelihood of its fracture. If conservative approaches fail, or symptoms are associated with either infection of the dental pulp or its irreversible inflammation, then root canal therapy will be recommended. At this point, extraction of the offending tooth is the only alternative to root canal therapy.

Timing is everything to the art and science of diagnosis, and making one, sometimes occurs only after additional time passes. It is important to understand and accept the fact that a CORRECT DIAGNOSIS WILL POINT THE WAY TO THE CORRECT TREATMENT, AND TREATMENT ONLY FOLLOWS ONCE A DIAGNOSIS IS MADE. This is the basis of all treatment and as dental health practitioners, must be followed. This phenomenon is complicated by the fact that tooth pain can be referred between the jaws, and non-odontogenic causes such as cardiac problems can also be responsible for tooth and jaw pain.

To this end, in some cases when a diagnosis is unclear or premature, your endodontist may recommend that you take pain medication (or even an antibiotic in some more rare cases) to keep you comfortable until signs and symptoms localize. Generally, as a rule, when odontogenic causes of pain exist, localization ensues rather quickly, somewhere in the neighborhood of 1-2 weeks, sometimes longer.

Often your endodontist will suggest a follow-up re-evaluation of your specific problem anywhere from 1 week to several months, depending on the severity of symptoms. It is important that you keep this appointment, there is no additional charge for this visit, or inform us if your particular situation changes, for better or for worse, and requires an alternative recall schedule.

There are then, about 10% of cases that are not tooth related, (non-odontogenic). These can include the following:

Migraines and other chronic headache, tempormandibular disorders (TMD), chronic back pain, myofascial pain and fibromyalgia, post- traumatic syndromes, neuralgias including trigeminal and post-herpetic neuralgia, atypical facial pain, post- traumatic trigeminal neuropathy, and complex regional pain syndromes. Sometimes cardiac problems can refer pain to the jaw and teeth as well. Cardiac problems can also mimic tooth pain, and refer pain to the lower jaw and upper extremities.

When your endodontist feels your symptoms are non-odontogenic you may be referred to the Wasser Pain Management Centre, (WPMC). This is a multidisciplinary assessment and treatment center that provides patient care, education and research in the area of chronic disabling pain disorders, and is located at Mt. Sinai Hospital. (wasser@mtsinai.on.ca)