Comparison of the Effects of Myotherapy in Patients with Myofascial Pain with and without Self-Reported Sleep Bruxism Using The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I Questionnaire.

BACKGROUND This study aimed to compare the effects of myotherapy using sublingual relaxation splints and stretching exercises in 110 patients with myofascial pain with and without self-reported sleep bruxism using The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I Questionnaire. MATERIAL AND METHODS The study involved 110 patients with myofascial pain. The diagnosis was based on the RDC/TMD questionnaire. The number of painful muscle sites (PMS) and the range of maximum mouth opening (MMO) were assessed 2 times - at the first visit and after 3 months. Then, the influence of possible bruxism on the treatment was assessed. RESULTS The mean age of the patients was 26.8 years (SD 5.4); 89% of the subjects were women; and 60.9% of the patients reported bruxism. Each patient was instructed to perform muscle stretching at the first visit and after 1 week all patients received a sublingual relaxation splint. The number of PMS decreased and the range of MMO increased in both groups after a period of 3 months of treatment (P<0.05). Significant differences were observed in the obtained treatment effects between the patients with and without possible bruxism. CONCLUSIONS This study evaluated the effectiveness of the sublingual relaxation splint and stretching exercises in patients with myofascial pain. Patients at a single center in Poland who reported myofascial pain that was not associated with self-reported sleep bruxism had a significantly better response to myotherapy when compared to patients with self-reported sleep bruxism.

[Botulinus toxin in complex treatment of myofacial pain syndrome]. / Botulotoksin v kompleksnom lechenii patsientov s miofastsial'nym bolevym sindromom disfunktsii visochno-nizhnecheliustnogo sustava.

The aim of the study was to assess the efficacy of type A Botulinus toxin (BTA) in pain release by TMJ functional pain disorders. The study included 211 patients with TMJ functional pain disorder (20.4% males and 79.6% females; mean age 45.3 years). The patients underwent clinical examination and bioelectric activity assessment of masticatory muscles by electromyography (EMG). EMG specters of 20 healthy volunteers with intact dental arches served as a control. After examination BTA was injected in muscular pain trigger points. All patients had muscular hypertonus, unilateral in 88.6% and bilateral in 11.4%. EMG showed the decrease of masticatory muscle activity on affected side to mean values of 165±20 mkV (30.0%, p<0.05) and on contralateral side to 460±31 mkV (89.6%, p>0.05). BTA injections in tensed muscles released significantly muscle-induced facial pain and improved quality of life. During 6 months follow up myofacial pain disorder relapse was seen in 3 patients. The results allow recommending BTA injection in muscular pain trigger points for treatment of myofacial pain syndrome and prolonged muscle relaxation.

Management of pain secondary to temporomandibular joint syndrome with peripheral nerve stimulation.

BACKGROUND: Temporomandibular joint syndrome, or Costen syndrome, is a clinically diagnosed disorder whose most common symptoms include joint pain and clicking, difficulty opening the mouth, and temporomandibular joint discomfort. The temporomandibular joint (TMJ) is supplied by the auriculotemporal nerve, a collateral branch of the mandibular nerve (the V3 branch of the trigeminal nerve). OBJECTIVES: The aim of this study is to assess the effectiveness and safety of permanent peripheral nerve stimulation to relieve TMJ pain. STUDY DESIGN: This case series is a prospective study. SETTING: Pain Unit of a regional universitary hospital. METHODS: The study included 6 female patients with temporomandibular pain lasting from 2 to 8 years that did not respond to intraarticular local anesthetic and corticoid injections. After a positive diagnostic block test, the patients were implanted with quadripolar or octapolar leads in the affected preauricular region for a 2-week stimulation test phase, after which the leads were connected to a permanent implanted pulse generator. Results of the visual analog scale, SF-12 Health Survey, Brief Pain Inventory, and drug intake were recorded at baseline and at 4, 12, and 24 weeks after the permanent implant. RESULTS: Five out of 6 patients experienced pain relief exceeding 80% (average 72%) and received a permanent implant. The SF-12 Health Survey results were very positive for all specific questions, especially items concerning the physical component. Patients reported returning to normal physical activity and rest at night. Four patients discontinued their analgesic medication and 1 patient reduced their gabapentin dose by 50%. LIMITATIONS: Sample size; impossibility of placebo control. CONCLUSION: Patients affected with TMJ syndrome who do not respond to conservative treatments may find a solution in peripheral nerve stimulation, a simple technique with a relatively low level of complications.

Piroxicam and laser phototherapy in the treatment of TMJ arthralgia: a double-blind randomised controlled trial.

This study aimed to evaluate the efficacy of piroxicam associated with low-level laser therapy compared with single therapies in 32 patients presenting temporomandibular joint arthralgia in a random and double-blind research design. The sample, divided into laser + piroxicam, laser + placebo piroxicam and placebo laser + piroxicam groups, was submitted to the treatment with infrared laser (830 nm, 100 mW, 28 s, 100 J cm(-2) ) at 10 temporomandibular joint and muscle points on each side during four sessions concomitant to take one capsule a day of piroxicam 20 mg during 10 days. The treatment was evaluated throughout four sessions and 30 days follow-up through visual analogue scale (VAS), maximum mouth opening and joint and muscle (temporal and masseter) pain on palpation. The results showed that all the study groups had a significant improvement in the VAS scores (P < 0·05), and there were no significant group differences. Piroxicam was effective in the reduction of joint and muscle pain on palpation (P < 0·05) and showed the lowest temporal pain (P = 0·02) at the 30-day follow-up. The combination of low-level laser therapy and piroxicam was not more effective than single therapies in the treatment of temporomandibular joint arthralgia. The use of piroxicam was more effective in the following 30 days.

Comparative effectiveness of traditional Chinese medicine and psychosocial care in the treatment of temporomandibular disorders-associated chronic facial pain.

UNLABELLED: This dual-site study sought to identify the appropriate role for traditional Chinese medicine (TCM; acupuncture and herbs) in conjunction with a validated psychosocial self-care (SC) intervention for treating chronic temporomandibular disorders (TMD)-associated pain. Participants with Research Diagnostic Criteria for Temporomandibular Disorders-confirmed TMD (n = 168) entered a stepped-care protocol that began with a basic TMD class. At weeks 2 and 10, patients receiving SC whose worst facial pain was above predetermined levels were reallocated by minimization to SC or TCM with experienced practitioners. Characteristic facial pain (CFP: mean of worst pain, average pain when having pain, and current pain; each visual analog scale [VAS] 0-10) was the primary outcome. Social activity interference (VAS 0-10) was a secondary outcome. Patients were monitored for safety. TCM provided significantly greater short-term (8-week) relief than SC (CFP reduction difference, -.60 [standard deviation of the estimate .26], P = .020) and greater reduction in interference with social activities (-.81 [standard deviation of the estimate .33], P = .016). In 2 of 5 treatment trajectory groups, more than two thirds of participants demonstrated clinically meaningful responses (≥30% improvement) in pain interference over 16 weeks. This study provides evidence that TMD patients referred for TCM in a community-based model will receive safe treatment that is likely to provide some short-term pain relief and improved quality of life. Similar designs may also apply to evaluations of other kinds of chronic pain. (ClinicalTrials.gov number NCT00856167). PERSPECTIVE: This short-term comparative effectiveness study of chronic facial pain suggests that TCM is safe and frequently efficacious alone or subsequent to standard psychosocial interventions. TCM is widely available throughout North America and may provide clinicians and patients with a reasonable addition or alternative to other forms of therapy.

Enhancing the efficacy of treatment for temporomandibular patients with muscular diagnosis through cognitive-behavioral intervention, including hypnosis: a randomized study.

OBJECTIVE: This study evaluated the efficacy of a cognitive-behavioral therapy (CBT), including hypnosis, in patients with temporomandibular disorders (TMDs) with muscular diagnosis. STUDY DESIGN: Seventy-two patients (65 women and 7 men with an average age of 39 years) were selected according to the Research Diagnostic Criteria for TMD, and assigned to the experimental group (n = 41), receiving the 6-session CBT program, and the control group (n = 31). All patients received conservative standard treatment for TMD. The assessment included pain variables and psychologic distress. RESULTS: There were significant differences between the groups, the experimental group showing a higher improvement in the variables evaluated. Specifically, 90% of the patients under CBT reported a significant reduction in frequency of pain and 70% in emotional distress. The improvement was stable over time, with no significant differences between posttreatment and 9-month follow-up. CONCLUSIONS: CBT, including hypnosis, significantly improved conservative standard treatment outcome in TMD patients.

Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for.

The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion, body posture and temporomandibular disorders (TMD). A search of the available literature was performed to determine what the current evidence is regarding: (i) The physiology of the dental occlusion-body posture relationship, (ii) The relationship of these two topics with TMD and (iii) The validity of the available clinical and instrumental devices (surface electromyography, kinesiography and postural platforms) to measure the dental occlusion-body posture-TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance. Furthermore, the literature shows that TMD are not often related to specific occlusal conditions, and they also do not have any detectable relationships with head and body posture. The use of clinical and instrumental approaches for assessing body posture is not supported by the wide majority of the literature, mainly because of wide variations in the measurable variables of posture. In conclusion, there is no evidence for the existence of a predictable relationship between occlusal and postural features, and it is clear that the presence of TMD pain is not related with the existence of measurable occluso-postural abnormalities. Therefore, the use instruments and techniques aiming to measure purported occlusal, electromyographic, kinesiographic or posturographic abnormalities cannot be justified in the evidence-based TMD practice.

Study on the effectiveness of the kinetic method in patients with rheumatic diseases and temporomandibular joint dysfunction.

UNLABELLED: Selecting the appropriate treatment decision is essential for achieving optimal results in the management of algo-dysfunctional syndrome of the temporo-mandibular joint (TMJD). The study aims to decide on the most effective (symptomatic control, preserved motility) kinetic program in patients with TMJ involvement. MATERIAL AND METHODS: prospective observational study on 83 consecutive patients with rheumatic diseases and TMJ dysfunction. Clinical assessment (pain, noises, muscle spasm, range of motion, ROM) was performed at baseline and after 3 months of specific kinetic rehabilitation program. Change in clinical parameters and TM3 index was reported, p<0.05. RESULTS: over 45% TMJ involvement at baseline as defined by TMJ index (mean value of 13.56) and only 36.66% at 3 months (p<0.05). Significant improvement in pain (presence, severity) was demonstrated at 3 moths (p<0.05): 18.05% spontaneous pain, 75.9% provoked pain, with 12.11% respectively 2.41% decreased in nocturnal respectively diurnal pain. Significant decrease (p<0.05) in joint noises at movements: 27.71% when opening and 12.04% when closing the mouth, 8.43 at protrusion and 3.61% at retraction, while 18% at the side movements. CONCLUSIONS: Complex accurate kinetic reeducation is mandatory for achieving correct posture (head, neck and trunk), normal mastication, swallowing and respiration, as well as correction of neuromuscular imbalances in patients with TMJD secondary to rheumatic disorders.

Integration of rehabilitation and acupuncture in the treatment of a professional musician with temporomandibular joint dysfunction.

This case study describes the use of acupuncture in a professional musician with myogenic temporomandibular dysfunction. The 3-year history of symptoms was associated with persistent episodic tension-type headaches. Acupuncture was used for trigger point release, primarily of the masticatory muscles, in conjunction with exercise therapy. After 8 weekly acupuncture sessions, the patient's pain had completely resloved, headaches had resolved and the Patient-Specific Functional Scale showed significant improvements.

Masseter muscle sonographic features as indices for evaluating efficacy of massage treatment.

OBJECTIVE: The aim of this study was to clarify the sonographic features of the masseter muscle as indices for judging the efficacy of massage treatment. STUDY DESIGN: Fifteen patients with temporomandibular disorder (10 with unilateral and 5 with bilateral muscle pain) underwent massage treatment alternately on the bilateral masseter and temporal muscles with an oral rehabilitation robot. Sonography was performed before and after treatment, and the masseter thickness and existence of anechoic areas were evaluated. RESULTS: The thickness on the symptomatic side in the unilateral group significantly decreased after treatment. Anechoic areas were shown in 20 muscles (66.7%) before treatment, and disappeared or were reduced in size in 17 muscles (85.0%) after treatment. The pretreatment thickness was significantly related to visual analog scale (VAS) scores regarding posttreatment muscle pain and massage impression. The existence of anechoic areas was relevant to VAS scores regarding muscle pain. CONCLUSION: Masseter thickness and existence of anechoic areas might be related to the therapeutic efficacy regarding muscle pain.

Emg analysis after laser acupuncture in patients with temporomandibular dysfunction (TMD). Implications for practice.

The aim of this study was to analyze the effect of low level laser applied to acupuncture points of patients diagnosed with temporomandibular dysfunction (TMD). Ten patients aged between 20 and 50 years were clinically examined with regard to pain and dysfunction of the masticatory system. They received laser applications (GaAlAs diode laser, 780 nm wavelength; 70 mW power output, 35 j/cm(2)) in acupuncture specific points (Ig4, C3, E6, E7) once a week, for ten sessions. The range of jaw movement was registered after each session and visual analogue scale (VAS) was applied. Results were analyzed (SPSS-15.0-Chicago) during the comparison, before and after treatment. Statistical tests showed significant improvements (p < 0.01) in painful symptoms and electromyographic activities of masseter muscles in maximal habitual occlusion after laser applications but no significant improvements (p = 0.05) in measurements of mandibular movements. The laser therapy in specific acupuncture points promoted improvement of symptoms and it may be used as complementary therapy for TMD.

Different substances and dry-needling injections in patients with myofascial pain and headaches.

Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain (MFP) patient management. However, few studies have analyzed their effect in a chronic headache population with associated MFP. The purpose of this study was to assess if trigger point injections using lidocaine associated with corticoid would be better than lidocaine alone, as in comparison with dry-needling in for the management of local pain and associated headache management. Forty-five (45) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point, were randomly assigned into one of the three groups: G1, dry-needling, G2, 0.25% lidocaine, at 0.25% and G3, 0.25% lidocaine at 0.25% associated with corticoid, and were assessed during a 12 week period. Levels of pain intensity, frequency and duration, local post-injection sensitivity, obtainment time and duration of relief, and the use of rescue medication were evaluated. Statistically, all three groups showed favorable results for the evaluated requisites (p < or = 0.05), but only for post-injection sensitivity did the association of lidocaine with corticoid present the best results and ingestion of rescue medication.

A follow-up study of subjective symptoms of temporomandibular disorders in patients who received acupuncture and/or interocclusal appliance therapy 18-20 years earlier.

OBJECTIVE: To evaluate the presence of symptoms of temporomandibular disorders (TMDs) in patients referred to a specialist clinic because of muscular problems 18-20 years earlier and who had received mainly acupuncture and/or interocclusal appliance therapy. MATERIAL AND METHODS: Sixty-five subjects who had received therapy at a TMD specialist clinic 18-20 years earlier were mailed a questionnaire with questions about TMD symptoms, their attitude towards the therapy, and their opinion about the outcome. Fifty-five subjects (85%) answered and returned the questionnaire. RESULTS: Before therapy, 87% had had severe TMD symptoms, but this figure decreased to 38% at the long-term follow-up. The mean values of the subjects' complaints at worst and at best before treatment, measured with a visual analog scale, were 66 (range 26-100) and 31 (range 0-100), respectively. The corresponding figures at the long-term follow-up were 32 (range 0-96) and 16 (range 0-70). Headache at least once a week was originally reported by 73% of the women and by 77% of the men. Headache prevalence 18-20 years later was 35% in women and 54% in men. The majority of patients were positive about the therapy they had received, and would recommend it to a friend with similar complaints. CONCLUSIONS: A majority of the patients reported a lasting improvement in their symptoms. Patients' overall opinions of the therapy received were positive.

[Efficacy of specific physiotherapy for temporomandibular joint dysfunction of muscular origin]. / Efficacité de la physiothérapie spécialisée sur les Sadam musculaires.

INTRODUCTION: Little explanation is given to patients with temporomandibular disorders and muscles dysfunction on the mechanism and the expected results of conservative treatment. The purpose of this prospective study was to evaluate the efficacy of specific physical therapy prescribed after this explanation was given and also after using a flat occlusal splint adapted only if muscle pain remained after physical therapy. MATERIAL AND METHOD: Twenty-seven patients with temporomandibular joint dysfunction of muscular origin were evaluated after a mean of six sessions of specialized physical therapy with professionals. Patients were treated by oral and facial massages and were trained for self-reeducation. They were also trained for a specific exercise named the "propulsive/opening maneuver". Every patient was questioned on the subjective evolution of pain and the current maximal pain was evaluated with the Visual Analogical Scale (VAS). Clinical evaluation focused on tenderness of masticator muscles and also assessed the changes in the amplitude of mouth opening. RESULTS: Ninety-three percent of the patients treated by specific physical therapy had a significant reduction of their maximal pain feeling (p<0.05). The recovery of an optimal mouth opening without deviation was also improved as was the protrusion. For 33% of the patients a flat nighttime occlusal splint was necessary as a complementary treatment. Twenty-two percent of the patients decided to change their treatment for alternative therapies (osteopathy, acupuncture, etc.). Fifty percent of the patients were convinced of the efficacy of the prescribed treatment. DISCUSSION: Patients who undertake the specific physical therapy and who regularly practice self-physical therapy succeed in relaxing their masticator muscles and in decreasing the level of pain. Explanations given by the doctor concerning the etiology of pain, during temporomandibular joint dysfunction of muscular origin, and the purpose of specific physical therapy increase the capacity of self-relaxation. A flat occlusal splint is indicated for patients who grind their teeth and for those whose pain resists to physical therapy.

Long-term effect on tinnitus by treatment of temporomandibular disorders: a two-year follow-up by questionnaire.

OBJECTIVE: The aim of the study was to investigate the presence of symptoms and signs of temporomandibular disorders (TMD) in patients with tinnitus and to evaluate the effect of TMD treatment on tinnitus in a long-term perspective in comparison with a control group of patients on a waiting list. MATERIAL AND METHODS: One-hundred-and-twenty patients with tinnitus were subjected to a clinical examination of the masticatory system and whether they had co-existing TMD to TMD treatment. Ninety-six patients had TMD, most frequently localized myalgia. Seventy-three of these completed the treatment and responded to a questionnaire 2 years later. Fifty patients with tinnitus who were on the waiting list served as a control group. RESULTS: Eighty percent of the patients had signs of TMD, most commonly myofascial pain. Forty-three percent of the patients reported that their tinnitus was improved at the 2-year follow-up, 39% that it was unchanged, and 17% that it was impaired compared to before the treatment. Twelve percent of the subjects in the control group reported that their tinnitus was improved compared to 2 years previously, 32% that it was unchanged, and 56% that it was impaired. The difference between groups was significant (chi(2): p<0.001). CONCLUSION: The results of this study showed that TMD symptoms and signs are frequent in patients with tinnitus and that TMD treatment has a good effect on tinnitus in a long-term perspective, especially in patients with fluctuating tinnitus.

Enfermedad de Jacob asociada con el síndrome de disfunción de la articulación temporomandibular: Presentación de un caso / Jacob’s disease associated with temporomandibular joint dysfunction: A case report

La enfermedad de Jacob se describe como una entidad infrecuente en la cual se establece una formación articular sinovial entre una apófisis coronoide mandibular elongada y el hueso malar homolateral. El Síndrome de disfunción de la articulación temporomandibular(ATM) ha sido postulado como posible factor etiológico del alargamiento este proceso coronoideo. Presentamos el caso de una mujer de 23 años con un desplazamiento discal de ATM de larga evolución y limitación de la apertura oral, que desarrolló una asimetría malar progresiva. La paciente fue sometida a tratamiento quirúrgico mediante una coronoidectomía intraoral y una artroscopia de la ATM homolateral en el mismo acto operatorio. El diagnóstico histológico de la apófisis coronoide examinada fue de exóstosis óseo-cartilaginosa con presencia de fibrocartílago articular en dicha formación. A pesar de la baja prevalencia de esta patología, debe ser considerada como un posible diagnóstico en aquellos pacientes con limitación progresiva de la apertura oral de larga evolución, si bien en ocasiones puede acompañarse de una disfunción articular crónica concomitante como posible causa de la misma

Jacob´s disease is regarded a rare condition in which a joint formation is established between an enlarged mandibular coronoid process and the inner aspect of the zygomatic body. Chronic temporomandibular joint (TMJ) disk displacement has been proposed as etiological factor of coronoid process enlargement. We present a 23-year-old woman with long-standing TMJ dysfunction and restricted interincisal opening, who developed a progressive zygomatic assymetry. The patient underwent treatment by intraoral coronoidectomy and homolateral TMJ arthroscopy in the same surgery. The histopathological diagnosis of the coronoid sample was cartilage-capped exostoses with presence of articular fibrous cartilage. Although the low prevalenceof this entity, it should be considered as a possible diagnosis inpatients with progressive limitation of mouth opening, althougha TMJ syndrome may be present as a cause of this entity

Tactile stimulation as a complementary treatment of temporomandibular disorders in patients with fibromyalgia syndrome. A pilot study.

Pain of long duration is a common suffering in modern man. One such pain condition is fibromyalgia syndrome (FMS). Opinions about what treatment regimen that are to be used in these patients are diverging, and many of the treatments suggested are not, or only poorly, scientifically investigated. The aim of this pilot investigation was to evaluate if FMS patients with signs and symptoms of temporomandibular disorders (TMDs) refractory to conservative TMD treatment would respond positively to tactile stimulation in respect of local and/or general symptoms. Ten female patients fulfilling the inclusion criteria received such treatment once a week during a 10-week period. At the end of treatment, a positive effect on both clinical signs and subjective symptoms of TMD, as well as on general body pain, was registered. Eight out of 10 patients also perceived an improved quality of their sleep. At follow-ups after 3 and 6 months some relapse of both signs and symptoms could be seen, but there was still an improvement compared to the initial degree of local and general complaints. At the 6-months follow-up, half of the patients also reported a lasting improvement of their sleep quality. One hypothetical explanation to the positive treatment effect experienced by the tactile stimulation might be the resulting improvement of the patients' quality of sleep leading to increased serotonin levels. The results of the present pilot study are so encouraging that they warrant an extended, controlled study.

A continuum of hypnotherapeutic interactions: from formal hypnosis to hypnotic conversation.

Hypnotherapeutic interactions can be mapped on a continuum from formal hypnosis to hypnotic conversation. Unlike the structured forms of formal hypnosis, hypnotic conversation relies upon utilizing the client's responses, both verbal and non-verbal, to facilitate therapeutic process. In this paper, we illustrate this continuum with a series of anecdotal clinical examples starting with formal hypnosis and moving incrementally towards hypnotic conversation. Finally, we offer an example similar in appearance to formal hypnosis, but now described in the context of hypnotic conversation. We are neither putting forth a theory nor offering a new perspective for those who research hypnosis as a phenomenon. Rather, these ideas and metaphors serve to broaden the framework of what constitutes hypnotic interaction so as to evoke new opportunities for increasing therapeutic efficiency and efficacy.

[Efficacy of treatment with hard and soft occlusal appliance in TMD].

Temporomandibular disorders (TMD) include clinical disorders involving the masticatory muscles, the temporomandibular joints (TMJ) and the adjacent structures. TMD was recognized as a main source for pains in the orofacial area, which are not caused from dental origin, and is defined by the American Academy of Orofascial Pain (AAOP) as a sub-group within the frame of musculoskeletal disorders. The main etiology for TMD has not been found yet. The customary treatments for this disorder include treatment with occlusal splints, physiotherapy, medicaments, behavioral-cognitive treatment, hypnosis, acupuncture and surgery that should be considered only if all conservative treatments were unsuccessful. Occlusal splint is the most common and efficient treatment for TMD patients proved by many studies with a successful rate of 70-90%. The following article reviews the different opinions in the treatment of TMD with special attention to hard and soft occlusal appliances. Based upon much research, and despite the many disagreements regarding its efficacy, the hard splint is a customary application which has the most successful outcome in patients who suffer from functional disorders of the masticatory system. The stabilization splint has an important benefit for being a non-penetrating and reversible appliance. However, despite this, the dentist should evaluate the joint or muscular problem, and seriously consider the various available treatments before deciding to use the appliance as a means of treatment.

Toothache of nonodontogenic origin: a case report.

This article describes the diagnosis and treatment of a patient exhibiting nonodontogenic tooth pain. A 25-yr-old female patient presented to postgraduate endodontics, SUNY at Stony Brook, for evaluation and treatment of pain associated with the upper and lower left quadrants. After thorough intraoral and extraoral examinations, it was determined that the pain was referred to the dentition from a trigger point in the masseter muscle. An extraoral injection of 3% Carbocaine was administered into the trigger point, and the pain abated within 5 min. The patient has experienced no recurrence of this pain for 12 months. Consideration of nonodontogenic dental pain should be included in a differential diagnosis.