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JADA Continuing Education

A Literature Review and Case Report

Background. Dentists need to be cognizant that temporomandibular disorder (TMD) –like pain can be caused by a tooth pulpalgia. The author provides suggestive symptom characteristics and definitive diagnostic techniques.

Case Description. A patient had severe bilateral TMD-like pain, which increased when something cold touched a premolar and when the patient lay down, and which awakened her several times every night. The author identified the offending tooth and administered a ligamentary injection along the tooth, which eliminated her bilateral TMD-like pain. Occlusal adjustment of her tooth reduced her pain, and subsequent endodontic therapy eliminated her pain. To the author’s knowledge, this is the first report of a pulpalgia in a posterior tooth causing bilateral TMD-like pain.

Clinical Implications. Pulpalgia may cause symptoms that mimic TMD or may contribute to TMD signs and symptoms. When patients with TMD-like pain report feeling increased pain due to a cold stimulus’ coming into contact with a tooth, practitioners should ensure that a pulpalgia is not contributing to their pain.

Key Words: Dental pulp; diagnostic challenge; masticatory muscles; pain; orofacial; root canal; temporomandibular disorder

Abbreviations: CNS: Central nervous system • TMD: Temporomandibular disorder • TMJ: Temporomandibular joint