Orofacial pain is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes. Definition Orofacial Pain is the specialty of dentistry that encompasses the diagnosis, management and treatment of pain disorders of the jaw, mouth, face and associated regions.These disorders as they relate to orofacial pain include but are not limited to temporomandibular muscle and joint disorders, jaw movement disorders, neuropathic and neurovascular pain disorders, headache, and sleep disorders.
It has also been suggested that the most basic etiologic classification of orofacial pain is into the following 3 groups:
Primarily somatic, arising from musculoskeletal or visceral structures, and transmitted via an intact pain transmission and modulation system.
Primarily neuropathic, which occurs as a result of abnormal or damaged pain pathways, e.g. a surgical or traumatic injury to a peripheral nerve.
Primarily psychological, which is rare
Diagnosis
Diagnosis of orofacial pain can be difficult and can require multiple examinations and histories provided by the patient. The pain history is essential and will indicate any further examinations required. The correct diagnosis of orofacial pain requires an in-depth pain history which will include:
Location of the pain
Timing
Duration
Associated symptoms
Exacerbating and alleviating factors
Description of the type of pain experienced e.g. dull, aching, throbbing, burning, tingling or pulsating.
Musculoskeletal including Temporomandibular diseases
Neuralgias and neuropathies
*Trigeminal neuralgia
*Glossopharyngeal neuralgia
*Sphenopalatine Ganglion neuralgia
*Sluder's Neuralgia
* Mental nerve neuralgia
*Post-injury
*Burning mouth syndrome
*Postherpetic neuralgia
Persistent idiopathic facial pain
*Atypical odontalgia
Mucosal
* Traumatic, immunologic, infective, erosive, ulcerative and vesiculobullous lesions e.g. oral ulceration
Psychosomatic
Sinonasal
*Rhinosinusitis
Headaches
*Cluster
*Migraine
*Tension-type
*Neoplastic
*Aneursym
Salivary gland disease
*Sialadenitis
*Sialoithiasis
Cardiac toothache
Eagle syndrome
Management
A multi-disciplinary approach is needed for orofacial pain disorders involving both non-pharmacological and pharmacological approaches which can be applied to the specific type of disorder. Non-pharmacological approaches can include physical therapies and psychological support to effectively manage the facial pain and reduce the negative impact on quality of life and daily functioning. Self-management interventions, such as education, jaw posture relaxation, and cognitive or behavioral self regulation, have been shown to improve long-term outcomes for patients with orofacial pain, specifically in patients with TMD. Self-Administration of Sphenopalatine Ganglion Blocks is an excellent approach to a wide variety of orofacial pain conditions. Often chronic orofacial pain requires referral to a specialised branch of medicine or dentistry or continuation of treatment in a primary care setting, if symptoms cannot be managed otherwise.
Orofacial pain is common problem. For example, in the United States, one report estimated that 22% of the general population had suffered from some form of facial pain at some point in the 6-month period before questioning, of which 12% was toothache. In the United Kingdom, 7% of the general population reported having some degree of chronic orofacial pain. Other reports indicate a prevalence of 10–15% for TMD in the general population. A systematic review looking at the prevalence of orofacial pain found that highest prevalence was for pain on opening the mouth, muscle tenderness and self-reported joint pain.
