J Oral Med Pain.  2024 Sep;49(3):57-64. 10.14476/jomp.2024.49.3.57.

Analysis of Final Diagnosis of Patients with Suspected Nonodontogenic Toothache: A Retrospective Study

• Chun JY
• Shim YJ

• KMID: 2560001
• DOI: http://doi.org/10.14476/jomp.2024.49.3.57

Abstract

Purpose
The aim of this study is to analyze the final diagnosis and the pain characteristics of patients with suspected nonodontogenic toothache and to contribute to the knowledge on differential diagnosis.
Methods
A retrospective analysis was conducted based on medical records from 185 patients. The following data were collected: age, sex, pain characteristics, radiographic results, initial diagnosis and treatment, and final diagnosis and treatment. The final diagnosis and the pain characteristics of the 3 most common final diagnoses were analyzed.
Results
Myofascial pain (MFP) was the most prevalent diagnosed condition accounting for 37.8% of cases, followed by pulpal pain (P) at 31.4%, and trigeminal neuralgia (TN) at 18.9%. There were significant differences in age, onset of the pain, and pain intensity across the 3 groups (all p<0.01). TN group exhibited a lower frequency of spontaneous and continuous pain than the MFP and P groups (all p<0.001). The proportion of patients reporting pain alleviating and aggravating factors related to dental pain was significantly higher in the P group than in the MFP and TN groups (all p<0.001). A concordance rate of 57.0% was observed between the initial and the final diagnosis. Twenty-six patients underwent tooth extractions and 24 patients had root canal treatments.
Conclusions
It is important to differentiate between dental pain and nonodontogenic toothache to avoid unnecessary dental treatments. Comprehending the pain characteristics of each condition, taking a thorough history taking, and performing diagnostic tests can help differential diagnosis.

Keyword

Diagnosis, differential; Myofascial pain syndromes; Toothache; Trigeminal neuralgia