Orofacial Pain Fact Sheet

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Fact Sheet

  • The general dentist and dental specialist treat patients with pain on a daily basis. Orofacial pain is pain perceived in the face and/or oral cavity. It is caused by diseases or disorders of regional structures, by dysfunction of the nervous system, or through referral from distant sources. Treatment of orofacial pain is a specialty in dentistry in many parts of the world and an emerging area of specialization in others.
  • Orofacial pain of potential neurovascular origin may mimic odontogenic pain to the extent that a large population of patients with migraine and trigeminal autonomic cephalgia seek dental remedies. Owing to the large variety of NOP entities, and in the absence of a singular or distinct pathophysiological rubric, this fact sheet discusses the more common NOP entities, namely odontogenic or dental pain, migraine, tension type headache, trigeminal autonomic cephalalgias, and other ominous headaches that mimic odontogenic pain and temporomandibular disorders.
  • Dental professionals agree that a distinct clinical entity that manifests as a persistent (chronic) continuous pain symptom located in the dento-alveolar region and cannot be explained within the context of other diseases or disorders. This entity, with ambiguity, has previously been referred to as atypical odontalgia, phantom tooth pain, and neuropathic tooth pain and as a subgroup within persistent idiopathic or atypical facial pain as well. Following a recent consensus exercise involving clinical experts and methodologists, the entity has been termed persistent dento-alveolar pain disorder (PDAP), and diagnostic criteria have been proposed.
  • Facial pain of odontogenic origin must not be overlooked as a possible source of chronic or complex orofacial pain. The assumption that a patient enjoys good dental health may not always be true. Pain arising from the teeth and supporting structures must always be considered during any examination of a facial pain patient.
  • Burning mouth syndrome (BMS) (also known as glossodynia, glossopyrosis, oral dysesthesia, or stomatodynia) is chronic oral mucosal pain or discomfort that has no identifiable causative lesions and is not caused by any other condition or disease.
  • Temporomandibular disorders (TMD) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joint (TMJ), the masticatory muscles, and all associated tissues. Pain associated with TMD can be clinically expressed as masticatory muscle pain (MMP) or TMJ pain (synovitis, capsulitis, osteoarthritis). Chewing or other mandibular activity usually aggravates the musculoskeletal pain. TMD pain can be (but is not necessarily) associated with dysfunction of the masticatory system (clicking or locking of the TMJ and limitation of jaw movement).
  • Persistent idiopathic facial pain (PIFP), previously termed “atypical facial pain,” is a persistent facial pain that does not have the characteristics of cranial neuralgias and cannot be better attributed to a different disorder.
  • Glossopharyngeal neuralgia (GPN) is a unilateral painful disorder that is characterized by brief, electric-shock-like pains, is abrupt in onset and termination, and is localized to the ear, the base of the tongue, the tonsillar fossa, or beneath the angle of the jaw. It has many of the same characteristics as trigeminal neuralgia (TN).
  • Trigeminal neuralgia (TN) is a unilateral painful disorder that is characterized by brief, electric-shock-like pains, is abrupt in onset and termination, and is limited to the distribution of one or more divisions of the trigeminal nerve. The revised International Classification of Headache Disorders -3 (ICHD-3) suggest three variants: (1) classical trigeminal neuralgia, often caused by microvascular compression at the trigeminal root entry to the brainstem; (2) trigeminal neuralgia with concomitant persistent facial pain; and (3) symptomatic trigeminal neuralgia, caused by a structural lesion other than vascular compression.
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