Among patients with nondescript facial pain referred to Raskin, about 10 percent have suspicious tooth extraction sites prior to onset of the pain and have positive responses to local infiltration of a local anesthetic. An aggressive oral surgical evaluation is obviously an important element in the evaluation of patients with facial pain, including trigeminal neuralgia. With appropriate stimulation of healthy diseased teeth, it is possible to analyze a variety of face and head pains that stem from the teeth. Use of locally acting anesthetics to interfere with toothache-induced headache allows one to assume that the painful experience was caused by afferent impulses arising from the stimulated tooth. Appropriate therapy will help resolve the matter.
Toothaches can produce severe headache.
Noxious stimulation of the tooth may produce sensations of fullness, numbness, and stiffness five minutes after the stimulation of a particular tooth. The temporomandibular joint syndrome or TMJ is probably overdiagnosed. Actual incidence is much less than what is actually diagnosed. Pain is caused by erosion of the bone of the glenoid fossa, with impaction of the condyles against the thin bone separating them from the dura and its rich nerve supply, irritation of the auriculotemporal nerve by uncontrolled medial and backward movement of the condyles, and irritation of the chorda tympani nerve by the condyle where it emerges from the tympanic plate at the medial edge of the glenoid fossa. According to Guralnick et al.