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when a painful toothache won't go away donald tanenbaum

When a Painful Toothache Won’t Go Away

Author: Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain

Date: June 30, 2011

I recently treated a 35 year old woman who was referred to my practice because she had a persistent toothache that continued though she already had a new filling placed, had her bite adjusted, and was constantly taking Advil and Tylenol. Based on how she described her tooth pain symptoms (variable in terms of the severity, frequency, and not related to eating or hot or cold fluids), I suspected that her pain was coming from somewhere, but not from her tooth!

You may ask how this that possible? To have a toothache that is not caused by a tooth? To begin to understand how you can experience pain in one area that is being caused by a problem somewhere else, it is important to become familiar with the concept of referred pain.

Referred pain is best understood when you consider the most common symptom reported by patients that are about to have or are in the midst of having a heart attack: pain in the left arm, the left side of the jaw, and under the chin. All caused by signals being sent by the heart muscle. You can only imagine that 100 years ago, before this connection was understood, doctors and community healers probably went to great lengths to sooth these left sided symptoms only to often fail with dire consequences.

The knowledge we have gained about referred pain through medical research not only has helped us recognize the signs of a heart attack, but have enabled us to also understand puzzling toothaches, face pains, ear symptoms, and other problems that often elude quick solutions. Getting back to the young woman with toothache: my evaluation uncovered that her symptoms were due to referred pain from the muscles of her upper neck! My patient was dumbfounded. How could the source of her painful toothache be her neck? But soon after her care began, her symptoms diminished and she is now happily toothache-free.

The care I applied was a combination of:

• Changing learned behaviors (posture, especially)

• Home exercises

• Physiotherapy

• Injections

It is routine to be asked by one of our patients, “Why does my ear, tooth, face, and eye hurt when I have been told by my physician and dentist that there is nothing wrong and they don’t see anything?” If this describes you, I assure you, you’re not “crazy.” Referred pain is real.

Muscle referred pain is just one of many topics I will be sharing on this blog. It is my hopes that these discussions will provide the insight and knowledge that you need to get proper care and guidance as you seek information to address your pain or that of other people in your life.

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