title: [Chronic orofacial pain (OFP) of different origin. A case report].
abstract: BACKGROUND
  Therapy of chronic orofacial pain (OFP) is often a challenge since OFP can be triggered by numerous medical conditions. Pulpitis is frequently related to acute OFP, only in rare cases pulpitis elicits chronic OFP e. g. due to a cracked tooth. Hypertrophy of masticatory muscles can also cause pain. While this pathosis is easily diagnosed, hypertrophy of masticatory muscles is challenging to treat.
  
  
  METHODS
  The presented case demonstrates a combination of a cracked tooth and a symtomatic hypertrophy of the masseteric muscle in a 19-year old patient. The patient suffered from diffuse chronic OFP for more than four month. After diagnosis an interdisciplinary step-by-step treatment plan was realized with re-evaluation and adjustment.
  
  
  RESULTS
  After physiotherapy and medicamentous pain control intramuscular injection of Botolinum toxin type-A was performed with remission of the muscle hypertrophy but only partial success regarding pain control. After root canal treatment of a cracked tooth the patient was free of symptoms.
  
  
  CONCLUSIONS
  The high degree of specialization in dental medicine requires a multidisciplinary approach for OFP not thoroughly responding to therapy. Stepwise diagnostics and treatments are recommended to clarify the pathology and to address multiple causes of disease.
authors: Klinik für Präventivzahnmedizin, Parodontologie und Kariologie, Zentrum für Zahnmedizin der Universität Zürich, Zürich, Switzerland. dan.rechenberg@zzm.uzh.ch
authors: Dan-Krister
authors: DK
authors: Rechenberg
authors: Astrid
authors: A
authors: Kruse
authors: Klaus Wilhelm
authors: KW
authors: Grätz
authors: Thomas
authors: T
authors: Attin
authors: Heinz-Theo
authors: HT
authors: Lübbers
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D003387:Cracked Tooth Syndrome / Q000150:complications* / Q000628:therapy; D005157:Facial Pain / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000150:complications / Q000188:drug therapy; D007273:Injections, Intramuscular; D008406:Masseter Muscle / Q000473:pathology*; D009135:Muscular Diseases / Q000150:complications / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage; D010348:Patient Care Team; D011671:Pulpitis / Q000150:complications / Q000628:therapy; D012390:Root Canal Therapy; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A