What is orofacial pain? 

Orofacial pain is a general medical term that is often used to describe pain that may be occurring in any part of the face including the jaws, scalp, mouth, and face. The pain may be caused by diseases or disorders of structures that make up the face and oral cavity. In some cases, the pain may be referred to the face area from the scalp or the ear. Today it is being recognized that in many cases, the most common source of orofacial pain is from the mouth. The second most common cause is related to the temporomandibular joint dysfunction (TMD). All the other causes of orofacial pain are rare. Orofacial pain disorders are quite challenging for the physician because pain can arise from many sources. Diagnosis and management of orofacial pain is now increasingly being managed by dentists, ear nose and throat specialists and sometimes even neurologists.

What are causes of orofacial pain?

There have been attempts to classify causes of orofacial pain but there is no one system that is universally accepted. The simplest way to classify causes of orofacial pain is as shown:

Oral Cavity causes

– Cracked tooth

– Dental cavities

– Dental abscess

– Teeth hypersensitivity

– Gingivitis

– Burning mouth syndrome

– Ulcers of the mouth

– Cancer of the mouth

Neuropathic pain

 Trigeminal neuralgia

 Glossopharyngeal neuralgia

 Mental nerve neuralgia

Headache

 Cluster headache

 Migraine

Temporomandibular joint dysfunction (TMD) 

Emotional causes

 Anxiety

 Depression

 Psychosomatic

How common is orofacial pain?

Orofacial pain is a very common problem in society. In the US alone, it is believed that nearly 1/5th of the adult population has had some type facial pain in the past 6 months. In the majority of cases, this pain is due to a dental problem like a toothache. Next most common cause of orofacial pain is temporomandibular pain, which is often chronic in nature. Orofacial pain can affect both genders and can occur at any age.

How do patients with orofacial pain present?

The majority of patients complain of pain near or inside the oral cavity. In some cases the pain is continuous and in others it may occur with facial movements like chewing, swallowing, biting or speaking. The pain is often a dull ache and may even occur at night. Orofacial pain is often unresponsive to the usual over the counter pain medications.


How is orofacial pain diagnosed?

The diagnosis of orofacial pain is not easy because there are many structures around the face and mouth that can cause pain. The majority of people go through many healthcare providers before a correct diagnosis is made. Eventually most people are referred to a dental surgeon or an ear nose throat specialist. Besides a through physical exam, one also
needs to undergo series of X-rays, CT scans and even MRI. One may need to see a number of specialists to determine the cause of pain.

How is orofacial pain managed?

The treatment of orofacial pain depends on the cause. If there is problem with teeth or
gums, this can be managed by the dentist. If the problem is TMD then the treatment will be geared towards restoring function of the jaw and limiting pain.

What are Home care remedies for TMD?

1. Patient education –the more a patient knows about the disorder the better is the outcome. Once patients learn that the condition is not life threatening, anxiety and pain are relieved.

2. Resting the muscles used for chewing and eating is also necessary; thus one may have to eat a soft diet, and apply moist heat or ice therapy.

3. If there is nighty grinding of the teeth this should be addressed by the dentist and wearing a night guard can help.

Physical therapy

Physical therapy is very helpful in restoring function of the TMJ. By strengthening muscles of chewing, this can help decrease inflammation and improve range of motions. It is best to enroll in a physical therapy program for a few weeks

Medications

Various medications are used to treat orofacial pain depending on the cause. The most common medications include use of: 

– Pain medications

– Injection of local anesthetics

– Corticosteroids

– Muscle relaxants

– Botox injections

– Use of antidepressants

Other Therapies

Some people with TMJ syndrome may also benefit from oral appliances and acupuncture. Surgical care is undertaken when medical therapy fails or is ineffective. Surgery is usually the last choice of treatment and should never be undertaken if one has not attempted physical therapy or pharmacological management first. Types of surgery to treat TMJ syndrome include injection of corticosteroids, aspiration or cleaning the joint.

Prognosis: 

In most cases of TMD, the prognosis is good. Recurrence of pain is rare after treatment. In all cases, the initial treatment is conservative. Home care remedies usually are tried out first, followed by medical care and then surgery, as the last option. 

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