Differential diagnosis of toothache to prevent erroneous and unnecessary dental treatment

Toothache represents the most common example of oro-facial pain. Its origin is mostly odontogenic, but several other conditions may mimic dental pain or present themselves as such. Well-known examples are myofascial pain, trigeminal neuropathies like neuralgia and painful post-traumatic trigeminal neuropathic pain, oro-facial neurovascular pains, cardiac pain and sinus disease. This review first discusses the current knowledge on the underlying pathophysiology of heterotopic tooth pain. Afterwards, several conditions potentially presenting as toothache will be illustrated regarding clinical features, diagnosis and management.