Related Experiment Video
Updated: May 6, 2026

Meal Duration as a Measure of Orofacial Nociceptive Responses in Rodents
Published on: January 10, 2014
Pathophysiology of referred pain in dentistry: a case report
Abstract:
This article presents the clinical case of a 42-year-old woman with chronic pain in her left temporomandibular joint (TMJ) and limited mouth opening. The patient also reported anxiety and difficulty sleeping. Cone beam computed tomography revealed impacted maxillary third molars and hypertrophy of the nasal turbinates. An auriculotemporal nerve block performed with 2% lidocaine decreased the pain but did not eliminate it, suggesting that the TMJ was not the primary source of the patient's pain. At a follow-up appointment 24 hours after the nerve block, infiltration anesthesia was administered via a simple buccal injection at the level of the impacted left third molar. The infiltration anesthesia completely eliminated the TMJ pain, indicating that the patient was experiencing referred pain (also known as heterotopic pain). The patient's anxiety and disordered sleep (possibly the result of hypopnea arising from hypertrophic nasal turbinates) could have produced a central hypersensitivity that initiated or exacerbated the referred pain. The patient was advised to consult an otorhinolaryngologist to evaluate her respiratory and sleep problems and a psychiatrist to evaluate her anxiety state. In addition, extraction of the third molars and continued dental follow-up were proposed. Dentists may encounter patients with chronic referred pain in daily practice. Additional research is needed to better understand the mechanisms of referred pain and contributory psychological factors, which would allow dentists to identify and apply the best treatment strategies for these patients.
Related Concept Videos
Nociception
Blood and Nerve Supply to the Bones
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...
Analgesia and Pain Management
Tooth Anatomy
The Crown, Neck, and Root
The visible part of the tooth is referred to as the crown. It's covered by enamel, the hardest substance in the human body. The crown is uniquely shaped for each type of tooth, allowing for different functions such as cutting, tearing, or...
Pain
Degenerative Disc Disease ll: Pathophysiology

