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What is Orofacial Pain?

Orofacial Pain and Headaches are complaints that around the world affect millions of people on a daily basis.  Together, they constitute any symptom that occurs from a large number of disorders and diseases and result in a sensation of discomfort or pain felt in the region of the face, mouth, nose, ears, eyes, neck, and head.

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When a person experiences pain in any other part of the body, often that pain or discomfort can be tolerated, endured, or ignored to some level, until symptoms become severe enough that the person seeks treatment.  When pain occurs in the orofacial region however, it often sparks an immediate attention response consisting of a significant level of concern, anxiety, and worry.

The orofacial region exists to perform many functions vital to human life support and therefore it is the most anatomically complex of all body systems, and has an enormous level of brain function and nerve supply dedicated to its daily operation.  The region performs functions such as breathing and smell, taste, sight, mastication (eating and chewing), swallowing, and communication (verbal and non-verbal).

Often, patients suffering from an orofacial pain disorder or headache have undergone numerous dental procedures, have seen multiple Doctors and Specialists, have taken or are taking many different prescription and non-prescription medications, and have had many medical tests, x-rays, CT scans, and MRI’s before being successfully diagnosed and treated.

Any patient with a chronic orofacial pain complaint should be seen by a specialist with experience in treating these conditions

Chronic orofacial pain presents very challenging diagnostic problems that are typically complicated by a variety of psychological and distressing factors, sleep disturbances, employment and family breakdowns, marriage and relationship difficulties, and complex medical conditions.  Therefore, patients with orofacial pain often require multidisciplinary treatment approaches, whilst a correct diagnosis requires time, understanding, and listening to the patient’s chief complaints and their thorough description of the pain history.  Typically these patients cannot be properly assessed and treated at a regular general dental practice due to the complexity of their medical, dental, and pain history.  Any person suffering from a chronic orofacial pain complaint should seek a referral to practitioners who specialise in orofacial pain disorders.

The vast array of Orofacial Pain categories may be intracranial (within the skull) or extracranial (outside of the skull) in origin and include:

1.  Idiopathic – of unknown origin
• Atypical facial pain
• Atypical odontalgia and phantom tooth pain
• Neuropathic facial pain disorder
• Burning mouth syndrome

2.  Musculoskeletal – arising from dysfunction of the muscles and / or bones and joints
• Masticatory muscle disorders
• Myofascial pain
• Myositis
• Myospasm
• Local myalgia

• Temporomandibular joint disorders
• Synovitis/capsulitis
• Osteoarthritis / Rheumatoid arthritis
• Disc displacement with reduction
• Disc displacement without reduction

• NICO (Neuralgia Inducing Cavitational Osteonecrosis) Lesions

• Bisphosphonate induced osteonecrosis of the jaw

• Tension-type and Cervicogenic (neck origin) headaches

 3.  Neuroalgic – functional change in the peripheral or central nervous system or nerve fibres
Episodic (occurs with periods of remission)
• Trigeminal neuralgia
• Glossopharyngeal neuralgia

• Herpetic neuralgia
• Postherpetic neuralgia
• Traumatic neuralgia
• Eagle’s syndrome

 4.  Vascular
• Giant cell (Temporal) arteritis
• Carotid artery dissection

5.  Neurovascular – arising from nerves and the blood vessels they supply
• Migraine
• Cluster headache
• Chronic paroxysmal hemicrania
• SUNCT headaches

6.  Psychogenic – containing an emotional or psychological component
• Somatoform disorders
• Factitious disorders
• Malingering

7.  Other diseases that can cause facial pain
• Local pathology – Dental decay and abscess, periodontal disease, tumours, and ulcers in the mouth
• Xerostomia (dry mouth syndrome)
• Trauma and / or surgery to the face
• Distant pathology (referred pain)
• Systemic diseases