Referred pain in Orofacial region:

# ___________most often refer pain to the temporal region,
while _________most often refer pain the ear.
A. Maxillary second premolars, mandibular molars
B. Maxillary molars, mandibular molars
C.  Maxillary second premolars, mandibular premolars
D. Maxillary molars, mandibular premolars

The correct answer is A. Maxillary second premolars, mandibular molars.

If careful diagnosis does not reveal the affected tooth, other teeth and related anatomic structures
become suspect. Pulpitis in one tooth may cause pain in other areas - the pain is referred.

Site of Pain Referral                             Pulp of Tooth Causing Pain
Forehead region                                    Maxillary incisors
Nasolabial area                                      Maxillary canines. premolars
Temporal region                                     Maxillary second premolars
Ear. angle of jaw, or posterior                 Mandibular molars
regions of neck
Mental region of mandible                        Mandibular incisors, canines. and premolars
Zygomatic, parietal, and occipital              Maxillary molars
regions of head
Opposing quadrant or to other                      Maxillary and mandibular molars
teeth in the same quadrant

Important: The nerve endings of cranial nerves VII, IX, and X are widely distributed within the subnucleus caudalis of the trigeminal (V) nerve. A profuse intermingling of these nerve fibers creates the potential for the referral of dental pain to many sites.

Orofacial pain can be the clinical manifestation of a variety of diseases involving the head and neck region. The cause of the pain must be differentiated between odontogenic and nonodontogenic.

Characteristics of nonodontogenic involvement:
• Episodic pain with pain-free remissions
• Trigger points
• Pain travels and crosses the midline of the face
• Pain that surfaces with increasing stress
• Pain that is seasonal or cyclic
• Pain accompanied by paresthesia

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