The aims of this study were: (1) to demonstrate how reproducible variations in incomplete
anesthesia of the inferior alveolar nerve can be used as a guide to locate the etiologic sites of referred trigeminal
pain emanating from the mandible; (2) to describe the salient histopathologic features of a lowgrade, nonsuppurative
osteomyelitis seen in this patient population. Forty-six patients with idiopathic
facial pain were subjected to a specific protocol of
local anesthetic injections to sequentially block branches of the mandibular nerve to determine the effects on his/her
pain. If this significantly reduced or altered the
pain on three separate appointments, then exploratory surgery was conducted near identified zones of unanesthetized gingiva. Blocking (92%), bridging (4%), and divergence (4%) were observed patterns of
anesthetic resistance of the mucogingival tissues used to categorize the incomplete
anesthesia. A 100% correlation was found between the identified zones of unanesthetized gingiva and the discovery of intramedullary pathology. Medullary
fibrosis with ischemic and degenerative changes in the cancellous bone were common findings, along with chronic inflammatory cell infiltrates and clusters of lymphocytes. It is concluded that Ratner's method of diagnostic
anesthesia be implemented when searching for occult
pain producing pathology of the jaws.