Arm pain of dental origin

Arm pain of dental origin Abbreviated

case report

E. Xteve Xewia, Lieutmaut Colonel, 1JIS’RF (DC),” Johvb D. Klarich, Major, USAP (MC)“”

and

DAVID

BASE,

GRANT

USAF

MEDICAL

CENTER,

TRAVIS

AIR

FORCE

CALIF.

An unusual case of referred pain is presented, The origin of the pain was the mandibular right second premolar. The areas of referr,al were the right mandible, neck, shoulder, medial arm, forearm, and wrist. The precise identification of the cause and the accurate description of the resultant pain by the patient, who is a physiei,an, give a special interest to this report.

0

ne of the difficult problems encountered in oral diagnosis deals with pain referred into, around, and out of the oral cavity. Although the mechanism of referred pain is still not clear, it would appear to be related to an “overflow” of painful afferent stimuli entering the sensory neuron pool, and there, where deep and cutaneous neurons overlap, the overflow stimuli from the deep fibers “fire” the cutaneous fibers, thus giving the illusion of pain at the referred site. Pain in a mandibular molar is often referred to the ear on the same side. During an attack of recurrent angina pectoris, pain is frequently experienced in the left mandible. Coronary thrombosis and myocardial infarction are also possible sources of severe pain referred into the mandible and maxil1a.l CASE REPORT The patient, from a carious was sensitive to On the morning entire right side the area of the The views

960

a 31-year-old male physician, had been experiencing intermittent pain mandibular right second premolar for approximately 2 weeks. The tooth occlusal forces, and the patient was unable to chew on the affected side. that he presented for treatment, the pain had progressed to include the of the mandible. The patient reported that, while brushing the teeth in mandibular right premolars, he experienced a “sudden, severe sharp pain

views expressed herein are those of the authors of the United States Air Force or the Department *Formerly Chairman, Department of Endodontics **Resident, Department of Surgery

and do not of Defense.

necessarily

reflect

the

Volume Number

Am

38 6

pain of dental origin

961

which radiated from the right mandible to the right neck, shoulder, medial arm, forearm, and wrist. The pain lasted 30 to 45 seconds, and several episodes were experienced over a period of approximately 45 minutes. This was followed by an intense sharp pain of the lower right face and pharynx which lasted for approximately 30 minutes until a mandibular block was given for relief of pain, ” Endodontic treatment was begun immediately and, on entry into the &amber, the pulp was found to be necrotic. However, remnants of “vital-appearing” pulp tissue were broached from the apical area of the root canal. Endodontic therapy w,as completed with no further difficulties, and the patient has had no recurrence of symptoms. REFERENCE

1. Ingle, Request

J. I.: reprints

Endodontics,

ed.

1, Philadelphia,

to:

Lt. Col. E. Steve Senia, Department of Endodontics Wilford Hall USAF Medical Center Lackland Air Force Rase, Texas 78236

1965,

Lea

& Febiger,

pp.

445-465.