Graff-Radford S B, Ketelaer M C, Gratt B M, Solberg W K
Section of Orofacial Pain and Occlusion, University of California, School of Dentistry, Los Angeles 90024-1668, USA.
J Orofac Pain. 1995 Spring;9(2):138-46.
Ongoing pain, intermittent sharp pain, or intermittent dull aching pain around the teeth can evoke the suspicion of tooth pathology. However, when no dental cause can be found clinically or radiographically, the differential diagnosis involving neuropathic pain and pulpal pathology is still a challenge. Neuropathic facial pains are still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy. The purpose of this study was to determine if electronic thermography was able to differentiate neuropathic facial pains presenting as toothache from pulpal pathology. Electronic thermography was used to compare asymptomatic subjects and subjects with neuropathic facial pains. Asymptomatic subjects and subjects with trigeminal neuralgia, pre-trigeminal neuralgia, and pulpal pain without periapical pathology showed no thermographic difference in the territory of the pain complaint when compared to the opposite nonpainful side. Patients with sympathetically maintained traumatic trigeminal neuralgia (atypical odontalgia) and half of the group with sympathetically independent traumatic trigeminal neuralgia presented with "hot" thermograms. The other half of the patients with sympathetically independent traumatic trigeminal neuralgia displayed "cold" thermograms in the area of their pain complaints. Electronic thermography was the least selective test for the group showing "cold" thermogram patterns (80% agreement with the thermographic characterization criteria). These data suggest that electronic thermography may be helpful in differentiating neuropathic pains from pulpal pathology.
牙齿周围持续疼痛、间歇性锐痛或间歇性钝痛可能会引发对牙齿病变的怀疑。然而，当临床或影像学检查未发现牙科病因时，鉴别诊断涉及神经性疼痛和牙髓病变仍是一项挑战。神经性面部疼痛仍常常被误诊为牙源性牙痛，导致不必要的拔牙或牙髓治疗。本研究的目的是确定电子热成像是否能够区分表现为牙痛的神经性面部疼痛和牙髓病变。电子热成像用于比较无症状受试者和患有神经性面部疼痛的受试者。与对侧无痛侧相比，无症状受试者以及患有三叉神经痛、三叉神经痛前期和无根尖周病变的牙髓疼痛的受试者在疼痛主诉区域的热成像上没有差异。患有交感神经维持性创伤性三叉神经痛（非典型牙痛）的患者以及一半的交感神经独立性创伤性三叉神经痛患者呈现“热”热成像图。另一半交感神经独立性创伤性三叉神经痛患者在其疼痛主诉区域显示“冷”热成像图。对于显示“冷”热成像图模式的组，电子热成像的选择性最低（与热成像特征标准的一致性为80%）。这些数据表明，电子热成像可能有助于区分神经性疼痛和牙髓病变。
