Headaches and dentistry

SHOULD someone who complains of constant headaches be referred to a dentist as part of that person’s final diagnosis and treatment? The answer is yes. Remember that the face is a part of the head, and the oral and peri-oral structures are part of the face, and pain can be referred to anywhere along the nerve’s path. Pain felt in the face can be concealed by a headache, with serious consequences if not explored and treated.

Dentists occasionally encounter patients who suffer from agonising pain somewhere in the mouth, which often includes areas of the face and neck. After routine examination, however, there is  nothing to justify the patient’s agony. Sometimes, the dentist may prescribe analgesics, not being sure what is causing the pain. But frequently, the pain either subsides mildly or not at all. The frustrated patient then seeks the help of another professional, only for the process to be repeated. However, any astute dentist will know that, in general, the diagnosis of facial pain is a complex process, and frequently the patient may be referred to a general medical practitioner.

The initial step in the diagnosis of facial pain is a thorough medical history, which should include a complete review of systems, family history, social history, and a cursory psychological evaluation. Special emphasis should be placed on disorders involving the head, neck, nose and throat because disorders affecting any of these areas may present with facial pain.

There are thirteen systemic disorders associated with facial pain and headache. Ischaemic heart disease, for example, produces pain that may be referred to the left side of the jaw, especially causing the molars to ache. People with high blood pressure, when undiagnosed or uncontrolled, experience vascular headaches which often radiate to the neck region.

A nervous disease called multiple sclerosis often results in neuralgia, a condition which is common. However, the most significant positive findings involving connective tissue disorders are arthritis and systemic lupus erythematosus. These can affect the joints and muscles of the jaw, resulting in myalgia (muscle ache) of the muscles involved in chewing. Arthritic involvement of the jaw joints and cervical spine can cause headache, neck pain and facial pain.

Significant historical findings involving the endocrine system include thyroiditis and low blood sugar. Common signs of thyroidism are muscle stiffness and myalgia. When undiagnosed, this disease might act as a perpetuating factor in chronic facial pain.

Certain factors may aid in diagnosis. Pain that occurs after a traumatic or stressful episode often implies that the cause is related to emotional factors. Neuralgia is mainly found in people over the age of 50, although younger people can be affected. Jaw joint disorders mostly affect people between the ages of 20 and 40 years.

It must be emphasised that the diagnosis and consequent management of headaches accompanied by facial pain is not necessarily a simple matter. A careful assessment should be made. Patients need to understand that the dentist may question psychological status (social stresses, etc.) and medical conditions (heart diseases) to ascertain the exact condition and to arrive at the appropriate treatment. Finally, whenever a person has a pain that they believe is coming from a tooth, but they are not sure which tooth it is, they should consider that the pain may not originate from a tooth at all and, therefore, the treatment may never be indicated in a definite manner.

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