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. Orofacial Pain (OFP) 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 (TMJ) disorders, jaw movement disorders, neuropathic and neurovascular pain disorders, headache, and sleep disorders.

Classification

International Classification of Diseases (ICD-11) is a new classification coming into effect as of January 1, 2022. It includes chronic secondary headaches and orofacial pain. The classification has been established by a close cooperation between International Association for the Study of Pain (IASP),

World Health Organization (WHO) The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...

and the International Headache Society (IHS). There are 4 main classifications prior to ICD-11 which attempt to classify the causes of orofacial pain. * The International Classification of Headache Disorders third edition (ICHD-3), a publication by the

International Headache Society The International Headache Society (IHS) is a London-based charity membership organisation that was founded in 1981 for those with a professional commitment to helping people affected by headache disorders and facial pains. In 1994, the IHS was ...

. https://ichd-3.org/ * The Classification of Chronic Pain Second Edition (Revised), a publication by the

International Association for the Study of Pain The International Association for the Study of Pain (IASP) is an international learned society promoting research, education, and policies for the understanding, prevention, and treatment of pain. IASP was founded in 1973 under the leadership of ...

. * Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, Fifth Edition b
American Academy of Orofacial Pain (AAOP)www.aaop.org
* The Research Diagnostic Criteria for Temporomandibular Disorders (see TMD). 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 (e.g. TMD pain or periodontal pain) or visceral structures (e.g. pulpal pain or pain from the

salivary gland The salivary glands in mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands ( parotid, submandibular, and sublingual), as well as hundreds of minor salivary glands. Salivary ...

s), 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 (See:

psychogenic pain Psychogenic pain is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors. Headache, back pain, or stomach pain are some of the most common types of psychogenic pain. Commonly it accompanies or is indu ...

)

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. Other information and examinations include: * Full medical history * Full dental history * Full social history * Clinical examination * Radiographic examination

Differential diagnosis

Clinical presentation of orofacial pain.

Dental related

* Pulpal ** Dentinal hypersensitivity resulting from ***

Caries Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complicatio ...

*** Toothwear ** Pulp disease (reversible and irreversible

pulpitis Pulpitis is inflammation of dental pulp tissue. The pulp contains the blood vessels, the nerves, and connective tissue inside a tooth and provides the tooth’s blood and nutrients. Pulpitis is mainly caused by bacterial infection which itself is ...

) resulting from *** Caries *** Trauma * Periapical pathology and periapical acute abscess * Periodontal **

Periodontal abscess A periodontal abscess (also termed lateral abscess, or parietal abscess), is a localized collection of pus (i.e. an abscess) within the tissues of the periodontium. It is a type of dental abscess. A periodontal abscess occurs alongside a tooth ...

Pericoronitis Pericoronitis is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle. The soft tissue covering a partially erupted tooth is known as an ''operculum'', an ar ...

and pericoronal abscess *

Cracked tooth syndrome Cracked tooth syndrome (CTS) is where a tooth has incompletely cracked but no part of the tooth has yet broken off. Sometimes it is described as a greenstick fracture. The symptoms are very variable, making it a notoriously difficult condition to d ...

Non-dental related

* Musculoskeletal including Temporomandibular diseases (TMD) * Neuralgias and neuropathies **

Trigeminal neuralgia Trigeminal neuralgia (TN or TGN), also called Fothergill disease, tic douloureux, or trifacial neuralgia is a long-term pain disorder that affects the trigeminal nerve, the nerve responsible for sensation in the face and motor functions such as ...

** Glossopharyngeal neuralgia ** Sphenopalatine Ganglion neuralgia ** Sluder's Neuralgia ** Mental nerve neuralgia ** Post-injury **

Burning mouth syndrome Burning mouth syndrome (BMS) is a burning, tingling or scalding sensation in the mouth, lasting for at least four to six months, with no underlying known dental or medical cause. No related signs of disease are found in the mouth. People with ...

Postherpetic neuralgia Postherpetic neuralgia (PHN) is neuropathic pain that occurs due to damage to a peripheral nerve caused by the reactivation of the varicella zoster virus (herpes zoster, also known as shingles). Typically, the nerve pain (neuralgia) is confined ...

* Persistent idiopathic facial pain (atypical facial pain) **

Atypical odontalgia Atypical facial pain (AFP) is a type of chronic facial pain which does not fulfill any other diagnosis. There is no consensus as to a globally accepted definition, and there is even controversy as to whether the term should be continued to be use ...

* Mucosal ** Traumatic, immunologic, infective, erosive, ulcerative and vesiculobullous lesions e.g. oral ulceration (e.g.

aphthous stomatitis Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term ''canker sore'' i ...

, erosive oral

lichen planus Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, and is only named that because it looks like one. It is characterized by polygonal, fla ...

, etc.) * Psychosomatic * Sinonasal **

Rhinosinusitis Rhinosinusitis is a simultaneous infection of the nasal mucosa (rhinitis) and an infection of the mucosa of the paranasal sinuses ( sinusitis). A distinction is made between acute rhinosinusitis and chronic rhinosinusitis. Background Because sin ...

* Headaches ** Cluster ** Migraine ** Tension-type **

Neoplastic A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

Aneurysm An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also be a nidus ( ...

* Salivary gland disease **

Sialadenitis Sialadenitis (sialoadenitis) is inflammation of salivary glands, usually the major ones, the most common being the parotid gland, followed by submandibular and sublingual glands. It should not be confused with sialadenosis (sialosis) which is a non ...

** Sialoithiasis * Cardiac toothache *

Eagle syndrome Eagle syndrome (also termed stylohyoid syndrome, styloid syndrome, styloid-stylohyoid syndrome, or styloid–carotid artery syndrome) is a rare condition commonly characterized but not limited to sudden, sharp nerve-like pain in the jaw bone and ...

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 (SPG or Pterygopalatine Ganglion) is an excellent approach to a wide variety of orofacial pain conditions. Often chronic orofacial pain (lasting over 12 weeks) 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. * Oral and maxillofacial referral for TMD * Primary care referral for tension-type headaches *

Neurology Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...

referral for migraines and cluster headaches *

Ear Nose and Throat Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...

referral for rhinosinusitis and midfacial segment pain

Epidemiology

Orofacial pain is common problem. For example, in the United States, one report estimated that 22% of the general population had experienced 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 (21%-49%), muscle tenderness (17%-97%) and self-reported joint pain (5%-31%).

References

External links

* BMJ Infographic
Identification and initial management of chronic orofacial pain
{{Medical resources , ICD10 = , ICD9 = , ICDO = , OMIM = , DiseasesDB = , MedlinePlus = , eMedicineSubj = , eMedicineTopic = , MeshID = D005157 Pain Symptoms and signs: Nervous and musculoskeletal systems