Wesley E. Shankland, II, D.D.S., M.S., Ph.D.
    TMJ & Facial Pain Center
    Columbus, OH


The diagnosis and treatment of orofacial pain are challenges to the clinician as well as frustrating to the one afflicted.  At least two reasons account for these observations.  Anatomically, the orofacial region is one of the most highly innervated areas of the human body, especially the oral cavity.  Referred pain patterns, collateral innervation, and multiple innervations of structures all confuse a person’s perception as to the location of the pain generator (i.e., a lesion or injured structure).  This honest confusion complicates the doctor’s diagnostic attempts.

In addition, the head and face are subject to chronic or recurring pain more than any other portion of the body.1  A 1983 study2 revealed that the average facial pain sufferer sought relief from at least six separate practitioners in their quest for an answer to their orofacial pain.  Thus, dentists engaged in general practice, treating the numerous, common dental conditions which produce pain, have a difficult task.

In this brief treatise, the topic of diagnosing neuralgia inducing cavitational osteonecrosis (NICO) of the jaws will be addressed.  However, before that subject is introduced, attention must be given to the differential diagnosis of a common and similar disorder, trigeminal neuralgia.

Continue reading the article:  Differential Diagnosis of NICO