Dear Spear fellows,

How are you doing?

I encountered a case today that I have problem figuring out what category it belongs, as I’ve never had pt complained pain to me at this area.

Pt is a 61-yr-old female pt. Dr. owner saw her at the 1/29/2020 hygiene visit, according to the note:

"Patient complained ‘ off and on having an ache on the lower left’. IOE: #18 DB cusp sensitive to percussion, #18 DL and ML cusps sensitive to tooth sleuth, craze line down the lingual of #18 – owner dentist recommended a crown for this tooth - we believe a crack is developing. "

The case was passed to me for crown prep, which I did on 8/5. Crown is in fabrication at the lab, #18 is in provisionalization.

Today (8/19) I saw the pt at her hygiene appointment. Here is my note:

"Pt complained of dull ache (2 out of pain scale 1-10 ) at the extraoral submandibular area near #18 ( pointing to this area ) since a year ago, a few times a day, lasting 10-20 min each time. Pt said the pain was reduced since I prepped on #18. "

SUMMARY: That means she experienced pain at this extraoral area for a year. 6 months ago, she described it to Dr. owner at the hygiene visit, who recommended a crown on #18. Now she still had pain at this area but reduced, probably with the hypoocclusion of temp crown at #18. What’s that mean? I’m not sure what the problem is, because I’ve never had patient complained to me with pain at the submandibular area extraorally ( unless it’s OS infection I guess, but she’s apparently not ). I couldn’t put this condition in a proper category that I’m aware of, so I told her I’d do some research. Here are my random thoughts: Is it endo ( but people with endo infection don’t usually point here )? Is it muscle pain related to clenching and grinding ( since #18 has crack line )? or is it neurological issue, not odontogenic origin?

Please share your thoughts and comments. Thanks!

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