Female, DOB: 4-10-54, referred by her periodontist
1.Sharp pain between teeth # 2, 3, 4,
described as being precipitated by flossing and touch interproximally but that heavier stimulation with use of a perio brush is OK.
2.She describes the palate to #2, 3,
4 as being sore since her periodontal surgery, 6 months prior
3.The bite feels disturbed, which she described as a habit of moving the jaw
back and forward grinding on a spot .
4.Painful jaw clenching, especially since the cementation of #3 full crown 3 months prior
5.Lower back pain, some upper quarter
(shoulder and cervical) pain and tenderness over the right hip.
6.Her overall pain intensity level was rated as usually 58 on a 0 to 100 VAS intensity scale, ranging from 50/100 to 80/100. Disability measured as the interference with general life function was rated as 45/100 and of jaw function 46/100. Her interference with sleep and rest was 70/100.
History of chief complaint:
• Prior to her periodontal surgery of the upper and lower right quadrants she denies any symptoms.
•She recalls a sensation of pressure, throbbing, and extreme hot/cold sensitivity following the subsequent preparation and temporary placement of a full crown on #3 .
•This pain reduced when the casting
was permanently cemented 1 week later.
•Following a root canal therapy on #3 in March 1995 the temperature sensitivity was resolved but a throbbing persisted.
•Interproximal stimulation between #3 and #4 however precipitates sharp pain. The periodontist had applied normal post operative periodontal measures but this pain has persisted.
- Peripheral allodynia:
- partially blockable with topical anesthetic and more completely with an infiltration.
- History doubts any missed dental cause.
- The only dental pains that are blockable
- by local anesthetic are gingivitis or mucosal ulceration, and possibly exposed root dentine. Otherwise probably a neuropathic pain.
- Most probably a peripheral neuropathic pain or a chronic pain with a peripheral pain component.
- Differential includes: traumatic neuralgia;
- c-fiber sensitization; neuroma.
- Defer additional dental procedures: if
- regional treatment required dentally then make sure you block all nociception
- and afferent input with good buccal and palatal local anesthesia infiltration, since this may otherwise worsen neuropathic sensitization.