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[Chronic orofacial pain (OFP) of different origin. A case report]
Dan-Krister Rechenberg1, Astrid Kruse, Klaus Wilhelm Grätz
1Klinik für Präventivzahnmedizin, Parodontologie und Kariologie, Zentrum für Zahnmedizin der Universität Zürich, Zürich, Switzerland. dan.rechenberg@zzm.uzh.ch
Introduction:
Therapy of chronic orofacial pain (OFP) is often a challenge since OFP can be triggered by numerous medical conditions. Pulpitis is frequently related to acute OFP, only in rare cases pulpitis elicits chronic OFP e. g. due to a cracked tooth. Hypertrophy of masticatory muscles can also cause pain. While this pathosis is easily diagnosed, hypertrophy of masticatory muscles is challenging to treat.
Methods:
The presented case demonstrates a combination of a cracked tooth and a symtomatic hypertrophy of the masseteric muscle in a 19-year old patient. The patient suffered from diffuse chronic OFP for more than four month. After diagnosis an interdisciplinary step-by-step treatment plan was realized with re-evaluation and adjustment.
Results:
After physiotherapy and medicamentous pain control intramuscular injection of Botolinum toxin type-A was performed with remission of the muscle hypertrophy but only partial success regarding pain control. After root canal treatment of a cracked tooth the patient was free of symptoms.
Conclusion:
The high degree of specialization in dental medicine requires a multidisciplinary approach for OFP not thoroughly responding to therapy. Stepwise diagnostics and treatments are recommended to clarify the pathology and to address multiple causes of disease.
