The purpose of this narrative review was to show that referred orofacial pain can be the chief symptom or a prominent symptom of visceral diseases of the chest and throat, with implications for dental and medical practice.
A search of PubMed was performed to identify dentally relevant clinical case reports and case series using the following terms: jaw pain, orofacial pain, toothache, temporomandibular disorders, otalgia, neuralgia, and neuropathicpain crossed with angina, myocardial infarction, carotid artery, esophagus, mediastinum, thyroid, heart, pericardium, aorta, lung, thymus gland, and stomach.
Numerous acute, visceral disorders of the throat and chest have been reported to produce pain in the orofacial region, which may be difficult to distinguish from dental-related diseases on the basis of symptoms alone. Chest organs and structures reported to cause such pain include the heart, aorta, esophagus, stomach, lungs, and mediastinum. Throat organs and structures reported to cause pain in the orofacial region include the thyroid gland, carotid arteries, and vagus and glossopharyngeal nerves. Coronary artery diseases, aortic and carotid dissection, mediastinal tumors, subacute thyroiditis, and gastroesophageal reflux disease have a predilection for referring pain orofacially.
Misdiagnosis of referred visceral orofacial pain can lead to delayed diagnosis and unnecessary treatment. Dentists can play a key role in the management of these conditions by means of ruling out odontogenic facial pain, promptly referring patients to medical specialists, and educating patients. Future research is needed to determine the incidence and mechanism of orofacial pain in these disorders. Visceral pain referred to the orofacial region may not be as rare a phenomenon as is sometimes assumed.

BACKGROUND: Persistent dentoalveolar pain of idiopathic origin represents a diagnostic challenge for the dentist and physician alike. Disagreement on taxonomy and diagnostic criteria presents a significant limit to the advancement of research in the field. Patients struggle with a lack of knowledge by dental and medical professionals, diagnostic delays, and unnecessary treatments.
METHODS: A PubMed search was performed as of January 1, 2017 by using the terms atypical odontalgia, phantom tooth pain, persistent idiopathic facial pain, painful posttraumatic trigeminal neuropathy, idiopathic toothache, persistent dentoalveolar pain disorder, nonodontogenic tooth pain, and continuous neuropathic orofacial pain. Three hundred forty-five abstracts were screened, and 128 articles that were pertinent to the topic went through full-text reading.
RESULTS: Case reports and narrative reviews constitute the majority of available literature. Several retrospective case-control studies investigated the clinical characteristics, pathophysiology, and diagnostic processes. Treatment strategies were evaluated in only 7 open-label and 2 randomized controlled trials.
CONCLUSIONS: Persistent dentoalveolar pain disorder is likely neuropathic in origin, but pathophysiological mechanisms to explain the onset and persistence of the pain are still far from understood. A correct diagnosis should be established before treatments are performed. Researchers should reach an agreement on the diagnostic criteria to enable a coherent research path to better understand the condition and reduce patient suffering.

THE OBJECTIVE OF THIS ARTICLE WAS TO PRESENT TWO NONODONTOGENIC CONDITIONS THAT MAY MIMIC ODONTOGENIC TOOTHACHE: trigeminal neuralgia and burning mouth syndrome. Two cases are presented in which one is related to the upper left second premolar and the other is related to the upper left first molar. Both showed pain when chewing. These two cases highlight the complexities involved in diagnosing nonodontogenic toothache. This article demonstrates the importance of having a thorough knowledge of both odontogenic and nonodontogenic toothache, as well as the need for careful evaluation of the nature of the pain and history, clinical and radiographic examinations.