Dental (odontogenic) pain

As a qualified dentist who previously worked in general dental practice (GDP), as well as across a range of dental specialties, I can work in conjunction with your GDP to help diagnose dental causes of pain.

What are the possible causes of dental pain?

These may be varied but include:

• reversible pulpitis: where the pulp or nerve tissue is inflamed but treatment with a simple filling is likely to still be possible
• irreversible pulpitis: where the pulp has begun to irreversibly “die” and is likely to require endodontic (root canal) treatment or removal
• apical periodontitis: where infection has spread out of the tip of the root into the surrounding tissues, typically causing pain on pressure/biting and necessitating endodontic treatment or removal
• pericoronitis: infection/inflammation around the crown of partially erupted teeth e.g. wisdom teeth
• “cracked tooth syndrome”: where a vertical crack exists in a tooth, causing pulpal inflammation, eventual necrosis and well-localised pain

I will use a variety of techniques to get to the source of the problem including examining you with light, mirrors, probes, magnification (where required), supplemented with imaging such as plain film radiograph and/or cross-sectional imaging such as low dose cone beam computed tomography (CBCT) scans.

What are the treatment options?

In cases of odontogenic or dental pain, I may recommend trying to salvage the tooth and communicate clearly with your GDP about the need for restorative treatment including endodontics. Where required, my referral network includes specialists in fields such as Restorative Dentistry, Periodontology and Endodontics. There may be a surgical component to this such as an apicectomy for teeth with symptoms following failed endodontic (root canal) treatment and/or apical cystic lesions. In these instances, I will work jointly with other specialist to ensure the problem is resolved but that you keep smiling during and at the end of treatment, preserving your natural dentition where possible but replacing any missing dental units with long-lasting prosthodontic replacement options such as bridges and/or implant-supported crowns.

Are there any other possible causes?

Yes, as an expert in facial pain, I am often asked to see cases which can “stump” general dental practitioners (GDPs). In these instances, a possible explanation may be either post-traumatic neuropathic pain or atypical odontalgia. These concepts are incompletely understood but often patients may be “hard wired” for pain centrally, with no obvious organic cause such as an identifiable dental issue. In the former case, this can be as a result of prior dental treatment. In these instances, it is important to ensure that unnecessary dental treatment is not performed on healthy teeth, but rather the focus shifts towards symptom control, potentially with multidisciplinary input from colleague in Anaesthesia with subspecialty interests in Pain Medicine.