Pain: is it all in your head? – Dr Michael Sultan

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  Posted by: Dental Design      27th February 2018

If there’s one thing that causes our patients more pain than anything else, it’s toothache. As dentists, we have front-row seats to the effects of this problem – and we know how debilitating it can be. Not only does toothache cause excruciating physical pain, it also causes incredible emotional turmoil, usually because it can stop us eating or sleeping properly. Of course, we all know the various reasons behind toothache – and, in most cases, we can treat it effectively. But it has always been a mystery exactly why toothache is so bad and causes so much physical and emotional suffering, especially when compared to other injuries or ailments. Indeed, many people would rate toothache as a far greater pain than a broken bone or sprain, and they regularly admit it is far more emotionally draining too.

Scientists in America may have recently discovered why this may be the case. A team from Duke University in North Carolina has found that sensory neurons from the teeth and face are wired directly to one of the brain’s principal emotional signaling hubs, while sensory neurons from the body are connected only indirectly. Pain signals from the head versus those from the body are carried to the brain through two different groups of sensory neurons, and it is thus possible that neurons from the head are simply more sensitive to pain than neurons from the body are.[1]

Their research also suggested that these pain groups which were directly connected to the facial area activated the brain’s emotional centres more dramatically than elsewhere. This would mean that the strong emotional reaction to toothache and similar ailments have a biological root cause that is, in the majority of cases, inescapable.

In practice, this means that we, as dentists, should not simply be focusing on the treatment of our patients’ pain, but responding to the emotional aspects of that pain as well. Of course, the majority of patients will only be concerned with the removal of the pain – that’s what they primarily come into the practice to have solved. And while we should adhere to our patients’ wishes and do everything we can to safely and efficiently provide a solution, we should also be mindful of their emotional response – not only to the pain, but to the solution too.

After all, the teeth are crucial to our self-esteem and self-image – and if the treatment we have proposed to remove their pain comes at the cost of extracting a tooth, then we have to help patients deal with this decision. Similarly, as we all know, dental treatment can cause incredible anxiety in patients – exacerbated by pain – and we must use all of our skill and expertise (not to mention our professional empathy) to help patients deal with these insecurities.

Another important aspect of dealing with the emotional response to dental pain and palliative treatment is aftercare. It is crucial that we do not simply ‘fix’ our patients and cut them off to fend for themselves. Even with relatively routine treatments, it is important to communicate with patients throughout the healing stage – even if it is to reassure them that everything is OK. Sometimes it is easy to forget, especially after hundreds of cases, that the patient might not realise that something we would recognise as normal is such. They might not realise that the ache or pain they are experiencing is part of the typical healing process and is nothing to worry about.

These emotional markers are crucial for not only effective healing, but also for building a strong relationship with the patient and assuage any fears they might have about future visits to the practice.

The research done by the team at Duke University, while certainly an enlightening look into the neurological repsonses to dental and facial pain, is more useful to us as a reminder to consider all aspects of our patient’s reaction to toothache – and can be used to direct our attitudes to dealing with both pre- and post-operative situations that might cause our patients emotional suffering. Indeed, it is the remit of any healthcare provider to care for the patient in the most wholesome and holistic manner, and by looking at toothache as more than just a physical pain to soothe, we can provide our patients with a better, more empathetic service in the future.

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[1] Dental Tribune: Toothaches: Why head and facial pain cause particular suffering. Link:


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