慢性疼痛と非歯原性口腔顔面痛の概要または鑑別診断

Chronic Pain and Overview or Differential Diagnoses of Non-odontogenic Orofacial Pain.

抄録

口腔顔面痛は、顔面および口腔領域から生じる痛みと定義される。歯の痛みは、この領域に現れる最も一般的な炎症性疼痛ですが、顎関節症（TMD）、一次性頭痛（神経血管性）、神経障害性疼痛、特発性疼痛状態など、頻繁に現れる慢性疼痛状態は、しばしば歯の痛みに類似していることがあります。歯科医師は顎関節症には精通していますが、主に三叉神経第一分節に現れる頭痛の診断や治療については訓練も経験もありません。<br/> 歯痛の痛みの現れ方が様々であるため、様々な慢性的な顔面痛を模倣し、不適切に処方された抗生物質や外科的介入を受けることになるのです。また、歯科医師だけでなく、耳鼻咽喉科医や顎顔面外科医も誤診に陥っているようです。

Orofacial pain is defined as pain arising from the regions of the face and mouth. Dental pain is the most common inflammatory pain presenting in this region; however, chronic pain conditions presenting frequently, including temporomandibular joint disorders (TMDs), primary headaches (neurovascular), neuropathic pain and idiopathic pain conditions, can often mimic toothache. Dentists are familiar with TMDs but have no training or experience in diagnosing or treating headaches that mainly present in the first trigeminal division. The anatomical complexity of the region and the potential possible diagnoses, mean that correct diagnosis is often delayed resulting in patients often undergoing inappropriate surgical and medical treatments that themselves may complicate the presentation of the pain by changing its phenotype and further complicating diagnosis and appropriate management.<br/> Due to the variable pain presentation of toothache, it can mimic many different chronic episodic orofacial pain conditions, resulting in many inappropriately prescribed courses of antibiotics and surgical interventions. Dentists are not the only profession to fall foul of the misdiagnosis but ear, nose and throat (ENT) and maxillofacial surgeons fall into the same trap.