Headache problems that can present as toothache

Toothache of nonodontogenic origin may be better differentiated with the use of differential diagnostic blockade. Table 9 reviews the expected outcome of somatic block at the site of pain and when the nerve division or the site of nociception is blocked. Although there is considerable overlap, this technique together with a careful history and detailed physical examination will prevent many unnecessary irreversible treatments. If no sign of periapical pathology can be determined (radiography is normal) and the dental examination is nonrevealing, at least a 4-month period should be allowed to elapse before considering any irreversible dental procedure. During this time pharmacologic trials may be attempted, bearing in mind the clinical presentation. Patients should be informed that it may take at least 4 months for the dental pathology to manifest and in the hope of preventing irreversible damage, careful observation accompanied by the pharmacologic trials will be carried out. The practicing clinician is encouraged to maintain a broad perspective of the differential diagnosis of toothache when the pathology is not obvious.