Referred pain originating from the superficial masseter muscle - a case report

Odontalgia can have a variety of causes1-6. This article deals with the case of a 41-year-old female patient with strong apical pain at the maxillary left second premolar that even led to a temporary disability to work. After a pretreatment of the painful situation elsewhere over several months, including a revision of the root canal filling at said tooth that had previously been unremarkable over many years, followed by an apicectomy and subsequent extraction of this premolar, the patient presented in the author's office. The patient wanted to have clarified whether an inflammation at the maxillary left first molar could be causing the pain. The pain site the patient complained about could not be verified, clinically, to be causing the condition. A functional diagnosis revealed a trigger point at the upper anterior edge of the left superficial masseter muscle as the primary site of pain, from which the pain was radiating. A hyperbalance between the maxillary left second molar and the mandibular left second molar could be established as the cause for the tenseness of this muscle, which felt hard and tendinous. After an adjustment of the occlusal interferences with direct composite restorations, adjunctive detoning physiotherapy and a relaxation scheme, the patient was without pain within a period of 5 weeks. Keywords: CMD, craniomandibular dysfunction, referred pain, heterotopic pain, trigger point, muscle palpation, manual exploration, malocclusion, hyperbalance, direct composite restorations