Mirror-image tooth pain referred from superficial masseter muscle - a case report

Toothaches are the main reason patients seek dental care, but not all pain in the orofacial region originates from the teeth. Some toothaches may stem from musculoskeletal, neuropathic, or neurovascular issues. Additionally, certain toothaches may not be tooth-related, but rather, referred from nearby orofacial structures, where the site and source of pain differ. In referred pain, the pain typically travels to the site from an ipsilateral source in the orofacial region. However, when the site and source of pain are on different parts of the body, but the pain is referred in a predictable manner, it is termed mirror-image pain. This case report illustrates mirror-image pain originating in the right mandibular tooth, referred from the contralateral superficial masseter muscle. A comprehensive history, thorough head and neck evaluation, an understanding of anatomy, and the utilization of diagnostic trigger-point injections were instrumental in reaching the correct diagnosis and the management of this non-odontogenic toothache, thus avoiding unnecessary dental interventions for managing the pain site.