Authors: Glick DH.
Title: The interpretation of pain of dental origin.
Journal: Dent Clin North Am
Date: Nov 1967
Citation: 535-48
Category: Diagnosis and Case Selection
Evidence-based Ranking: 5
Discussion: Dental pain manifests itself in 3 different clinical expressions: pulpal, periapical and periodontal. Pulpal pain has many manifestations. Hypersensitive dentin arises from the irritation of the dentin by chemical, thermal or mechanical stimuli. Hyperemic pain on the other hand is caused by increased vascularity while pain from pulpitis originates from inflammation of the pulp. Pulpitis is further divided into acute and chronic types. Pain arising from periodontal tissues may originate from infection. A dull, steady, continuous type of pain characterizes periodontal pain. Also, occlusal traumatism can cause this type of pain. Finally, periapical pain can be coming from 2 painful apical lesions: the acute apical periodontitis and acute apical abscess. Referred pain seems to arise in an area other than its origin and involves a radiation or transmission of pain to an adjacent or distant area supplied by the same or related nerve. Prolonged disturbances give rise to distant pain. Sometimes pain occurs from tooth to tooth. Pain from a single tooth maybe referred to almost any point on the same side of the trigeminal nerve. Also, pain from an upper tooth may be referred to a lower tooth and vice versa, especially to a same type of tooth. Mandibular incisor, canines and first premolars will refer to the mental area. 2nd premolars will refer to the mental and midramus area. 1st and 2nd molars will refer pain to the ear and the area around the angle of the mandible. Similarly, maxillary central and lateral incisors refer pain to the frontal area. Canines and 1st premolars will refer pain to the nasiolabial and infraorbital areas. 2nd premolars refer to the temporal and maxillary area, 1st molars refer pain to the maxillary area while 2nd and 3rd molars will refer to the mandibular area and the ear.

Reviewer’s comments: The article describes different modalities of dental pain as well as descriptions and examples of referred pain.