Goel Rajat, Kumar Sanjeev, Panwar Ajay, Singh Abhishek B
Department of Endodontics, SGT Dental College Hospital and Research Institute, Gurgaon, India.
Department of Medicine, Lala Lajpat Rai Memorial Medical College, Meerut, India.
Open Dent J. 2015 Jul 31;9:337-9. doi: 10.2174/1874210601509010337. eCollection 2015.
Orofacial pain' most commonly occurs due to dental causes like caries, gingivitis or periodontitis. Other common causes of 'orofacial pain' are sinusitis, temporomandibular joint(TMJ) dysfunction, otitis externa, tension headache and migraine. In some patients, the etiology of 'orofacial pain' remains undetected despite optimal evaluation. A few patients in the practice of clinical dentistry presents with dental pain without any identifiable dental etiology. Such patients are classified under the category of 'atypical odontalgia'. 'Atypical odontalgia' is reported to be prevalent in 2.1% of the individuals. 'Atypical orofacial pain' and 'atypical odontalgia' can result from the neurological diseases like multiple sclerosis, trigeminal neuralgia and herpes infection. Trigeminal neuralgia has been frequently documented as a cause of 'atypical orofacial pain' and 'atypical odontalgia'. There are a few isolated case reports of acute pontine stroke resulting in 'atypical orofacial pain' and 'atypical odontalgia'. However, pontine stroke as a cause of atypical odontalgia is limited to only a few cases, hence prevalence is not established. This case is one, where a patient presented with acute onset atypical dental pain with no identifiable dental etiology, further diagnosed as an acute pontine infarct on neuroimaging. A 40 years old male presented with acute onset, diffuse teeth pain on right side. Dental examination was normal. Magnetic resonance imaging(MRI) of the brain had an acute infarct in right pons near the trigeminal root entry zone(REZ). Pontine infarct presenting with dental pain as a manifestation of trigeminal neuropathy, has rarely been reported previously. This stresses on the importance of neuroradiology in evaluation of atypical cases of dental pain.
口面部疼痛最常见的原因是龋齿、牙龈炎或牙周炎等牙科问题。“口面部疼痛”的其他常见原因包括鼻窦炎、颞下颌关节（TMJ）功能障碍、外耳道炎、紧张性头痛和偏头痛。在一些患者中，尽管进行了最佳评估，“口面部疼痛”的病因仍未被发现。临床牙科实践中有少数患者表现出牙痛，但没有任何可识别的牙科病因。这些患者被归类为“非典型牙痛”。据报道，“非典型牙痛”在2.1%的个体中普遍存在。“非典型口面部疼痛”和“非典型牙痛”可能由多发性硬化症、三叉神经痛和疱疹感染等神经系统疾病引起。三叉神经痛经常被记录为“非典型口面部疼痛”和“非典型牙痛”的原因。有一些孤立的病例报告称急性脑桥中风导致“非典型口面部疼痛”和“非典型牙痛”。然而，脑桥中风作为非典型牙痛的病因仅限于少数病例，因此其患病率尚未确定。本病例中，一名患者出现急性发作的非典型牙痛，无可识别的牙科病因，经神经影像学检查进一步诊断为急性脑桥梗死。一名40岁男性出现急性发作，右侧牙齿弥漫性疼痛。牙科检查正常。脑部磁共振成像（MRI）显示右侧脑桥靠近三叉神经根入区（REZ）有急性梗死。以前很少报道脑桥梗死以牙痛作为三叉神经病变的表现。这强调了神经放射学在评估非典型牙痛病例中的重要性。
