The differential diagnosis of toothache from other orofacial pains in clinical practice

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Teeth are a common and obvious source of orofacial pain. There is a risk that endodontic treatment may be initiated in patients that do not have pulp or periapical pathosis.


A retrospective survey of a sample of patients referred for endodontic treatment was analysed to determine the accuracy of the diagnosis and to identify non-dental cases. A separate prospective study of complex non-dental orofacial pain cases was performed to determine which cases had previously received dental treatment.


Seventy-seven (88 per cent) of 88 patients referred for endodontic treatment had been correctly diagnosed with solely endodontic problems. Eight (9 per cent) had endodontic plus other orofacial pain problems and three (3 per cent) had no endodontic problems but other orofacial pain problems. Fortyfour (44 per cent) of 100 non-dental orofacial pain patients had previously received either extractions or endodontics.


Dentists need to carefully evaluate all toothache patients to ensure that the diagnosis is correct prior to the initiation of irreversible treatment.

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