Pain management of cervicogenic odontalgia caused by cervical spondylosis and herniration of pulposus - A case report

Orofacial pain is frequently associated with nonodontogenic disease. We report a case of cervicogenic odontalgia caused by cervical spondylosis and disk herniation. A 55-years old female suffering from pain in the right lower first molar visited a dental office. Her condition was diagnosed as pulpitis and treated by pulpectomy and root canal treatment. However, the severe tooth-ache persisted even after the treatment. The patient was referred to Department of Oral Surgery at the Kyushu Dental College where it was suspected that the pain might have been caused by mandibular myelitis, and was treated with antibiotics for two weeks but without any effect. The patient was then referred our clinic. In addition to the tooth-ache, the patient complained of continuous dull pain on her right side of the occipital region, lower jaw, neck and shoulder. The referred pain to the above mentioned sites could be induced by palpating the right masseter, trapezius and sternocleidomastoideus and thus we diagnosed it as myofascial pain syndrome. Trigger point injection in right masseter, trapezius and sternocleidomastoideus with 1% mepivacaine was effective for pain relief in the neck, lower jaw, shoulder and the occipital region of the head, but not the tooth-ache. Further inquiry revealed that the patient had anamnesis of post-traumatic neck syndrome for ten years. Pressure to C₄ and C₅ transverse process caused referred pain at right lower first molar. A bone spur and the arched intervertebral foramen were observed at C_4/5 and C_5/6 with plain film and computed tomography (Fig. 1). Also, herniation of the nucleus pulposus was observed at C_4/5, C_5/6 and C_6/7 with magnetic resonance imaging (Fig. 2), which led us to diagnose the case as cervicogenic odontalgia. The severe tooth-ache was successfully treated with a cervical nerve plexus block and a cervical epidural anesthesia. A dentists should be aware the cervicogenic diseases such as spondylosis and nucleus pulposus cause odontalgia.