Orofacial pain (OFP) is a general term covering any

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

which is felt in the mouth, jaws and the face. Orofacial pain is a common

symptom Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

, and there are many causes. Orofacial pain is the specialty of

dentistry Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the Human tooth, teeth, gums, and Human mouth, mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, dis ...

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 A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

(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 which coordinates responses to international public health issues and emergencies. It is headquartered in Geneva, Switzerland, and has 6 regional offices and 15 ...

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. 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 many vertebrates including 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 min ...

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, without evidence of physical injury or illness. Headache, back pain, or stomach pain are some of the most common types of psy ...

)

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 caries,The word 'caries' is a mass noun, and is not a plural of 'carie'.'' is the breakdown of teeth due to acids produced by bacteria. The resulting cavities may be a number of different colors, from yellow to black ...

*** Toothwear ** Pulp disease (reversible and irreversible pulpitis) resulting from *** Caries *** Trauma * Periapical pathology and periapical acute abscess * Periodontal ** Periodontal abscess ** Pericoronitis and pericoronal abscess * Cracked tooth syndrome

Non-dental related

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

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

** 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). PHN is defined as pain in a dermatomal distributi ...

* Persistent idiopathic facial pain (atypical facial pain) ** Atypical odontalgia * Mucosal ** Traumatic, immunologic, infective, erosive, ulcerative and vesiculobullous lesions e.g. oral ulceration (e.g.

aphthous stomatitis Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), commonly referred to as a canker sore or salt blister, is a common condition characterized by the repeated formation of benignity, benign and non-contagious disease, contagious mouth ...

, erosive oral

lichen planus Lichen planus (LP) is a chronic inflammatory and autoimmune disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, but is named for its appearance. It is characterized by polygonal, flat-topped, violaceous p ...

, etc.) * Psychosomatic * Sinonasal ** Rhinosinusitis * Headaches ** Cluster **

Migraine Migraine (, ) is a complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea, and light and sound sensitivity. Other characterizing symptoms may includ ...

** 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 :wikt:bulge, 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 b ...

* 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 ...

** 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 (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 , "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine) , medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous syst ...

referral for migraines and cluster headaches * Ear Nose and Throat 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%).

Feline orofacial pain syndrome

Feline orofacial pain syndrome is a condition in cats characterised by episodic unilateral oral pain and self-mutilation of the tongue. The aetiology is unknown but is believed to be a neuropathic inherited disorder. Common

analgesic An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

s often do not work well and

anti-convulsant Anticonvulsants (also known as antiepileptic drugs, antiseizure drugs, or anti-seizure medications (ASM)) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also used in the treatment ...

analgesics are required to manage pain. The

Burmese cat The Burmese cat (, , or , or , meaning copper colour) is a cat breed, breed of domestic cat, originating in Myanmar, Burma, believed to have its roots near the Myanmar–Thailand border, Thai–Burma border and developed in the United Sta ...

is predisposed.

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