What is it?
Atypical facial pain is a dull, deep and at times burning pain that is present for most of the day. Examination, tests and imaging show no cause belonging to a tooth or the jaw. The edges of the pain do not sit neatly inside the anatomical area of a single tooth or a single nerve, and you may not be able to point to the exact spot with a finger.
The problem appears to lie not where the pain is felt, but along the route where the pain signal is carried and processed. Nerve endings and central pain pathways can grow more sensitive over time, and stimuli that would not normally hurt are read as pain. This does not mean the pain is imagined. The pain is real; it is only its source that is not in the expected place.
When this picture is not recognised, the road taken is usually the same: first a filling is replaced, then root canal treatment, then root end surgery and finally extraction. After each procedure the pain changes for a short while, then comes back to the same area or to a neighbouring tooth. As irreversible work piles up, the picture is not expected to become any easier.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Nerve changes after a procedure or an injury
After an extraction, root canal treatment, an implant or surgery, the fine nerve endings in the area can start working differently. The pain can carry on even weeks after the site has healed, and numbness or burning can come with it.
- 02
Pain pathways growing more sensitive
Long-standing pain lowers the threshold of the pathways carrying the signal. After a while, even a light touch or a change in temperature can be read as pain. This change does not show on imaging; it is worked out from the examination and the history.
- 03
Broken sleep and constant tension keeping the pain going
Broken sleep and long-standing tension lower the pain threshold, and the pain in turn disturbs sleep. This cycle is not the cause of the pain, but it makes it easier for the pain to carry on, which is why it is part of the assessment.
- 04
A delayed diagnosis and repeated procedures
Every new procedure adds a fresh load on the tissue and the nerves in the area. Work carried out on a trial basis for pain whose cause has not been shown can complicate the picture rather than settle it.
How does it progress?
- Type 1
Atypical odontalgia
The pain settles on a single tooth or on the socket of a tooth that has been taken out. The tooth is vital and the tests are normal; the pain may not change with biting or with heat and cold.
- Type 2
Persistent facial pain
The pain covers a wide area such as the cheek, the upper jaw or below the eye, and its edges are unclear. It is usually one-sided and its severity rises and falls through the day.
- Type 3
Nerve pain after a procedure
The pain starts after a particular procedure. Numbness, tingling or burning may be present in the same area, and touch can make the pain worse.
How is it treated?
The first step is to rule out a dental cause with care. Vitality testing, biting and percussion tests, radiographs taken at suitable angles and, where needed, three-dimensional imaging are carried out. If there is no finding, root canal treatment, root end surgery or extraction is not planned for the sake of a diagnosis. Setting this limit from the outset is what keeps the picture from becoming more tangled still.
Care is shared. Confirming the diagnosis and the medication belong to a pain clinic or to neurology; the medicines used for this pain work differently from ordinary painkillers, and the choice is the doctor's decision. The dentist's contribution is to keep an eye on the dental situation, to reduce extra loads such as clenching, and to stop unnecessary work.
Setting a realistic expectation is part of the treatment. What is aimed at is most often not ending the pain at a stroke, but reducing its severity and its effect on daily life step by step. A simple diary recording where the pain is, what time it comes and how severe it is makes it easier to see which approach is helping, and it makes follow-up appointments productive.
- Numbness newly starting in the lip, chin or tongue along with the pain
- Swelling in the face, fever or difficulty opening your mouth
- A sore that will not heal, bleeding or a lump you can feel in the painful area
- General symptoms such as weight loss and night sweats being added to the picture
How is it prevented?
- Do not ask for irreversible work on a trial basis for pain whose cause has not been shown.
- Keep a written note for a few weeks of where the pain is, what time it comes, how severe it is and what changes it.
- Pass on to your new dentist the work already carried out in the same area and the dates of it.
- Talk through with your dentist the things that feed the pain, such as your sleep pattern and teeth clenching.
Frequently asked questions
- Nothing showed on the X-ray, so is my pain not real?
- Your pain is real. Imaging shows changes in hard tissue; it does not show a change in the way the pain signal is processed. An X-ray with no findings does not say the pain is absent, it says the cause should not be looked for in the hard tissue of the tooth.
- If I have the painful tooth taken out, will it go away?
- In pain whose cause has not been shown, extraction is not expected to end the pain. The pain most often changes for a while and then comes back to the same area or to a neighbouring tooth, and on top of that a loss has been suffered that cannot be undone. For this reason extraction only comes up if there is a clear finding belonging to the tooth.
- Will this pain go away completely?
- The course varies from person to person. In some people the pain eases markedly and there are long quiet stretches; in others it carries on in waves. No definite length of time or outcome can be given. With suitable care, what is most often aimed at is a fall in the severity of the pain and in its effect on daily life.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.