Orofacial Pain (OFP) refers to pain associated with the hard and soft tissues of the head, face, and neck. These tissues, whether skin, blood vessels, teeth, glands or muscles send impulses through the trigeminal nerve (fifth cranial nerve) to be interpreted as pain by the brain. Orofacial pain, of which about 10% is chronic, affects around a quarter of the general population. The complaint of OFP encompasses a diagnostic range from neurogenic, musculoskeletal and psychophysiological pathology to headaches, cancer, infections, autoimmune phenomenon, and tissue trauma.
Orofacial pain is a relatively common complaint in general medicine and dental practice. Diagnosis and treatment of OFP originating from the oropharyngeal region, facial area, ears, sinonasal area, and neck is a complex process compounded by the density of anatomical structures and the prominent psychologic significance attributed to this region. Management of OFP thus demands the service of clinicians from various specializations such as Dentistry, Otolaryngology, ophthalmology, neurology, neurosurgery, psychiatry and psychology. Complex referral patterns to adjacent structures are common in OFP and, indeed, one person’s headache is another person’s facial pain. In clinical practice, the two types of pain are often intimately related. Consequently, a patient with OFP may wander from one specialty to another to try to find adequate help.
The quest to better manage pain problems involving the head and neck area such as headaches, facial pain, and temporomandibular disorders has led to the establishment of OFP as a discipline in the field of dentistry. A huge step in the recognition of OFP as a discipline in dentistry occurred in 2009 when the Commission on Dental Accreditation (CODA) approved OFP as an area of advanced education.
A vast variety of disorders fall under the umbrella of OFP disorders, to name a few, musculoskeletal pain disorders (Myositis, arthralgia, Myofascial pain, fibromyalgia, temporomandibular joint disorders), Neurovascular pain disorders (like migraines, tension-type headaches, trigeminal autonomic cephalgias), Neuropathic pain disorders (like trigeminal and glossopharyngeal neuralgia, burning mouth syndrome, postherpetic neuralgia, traumatic neuroma), Intraoral pain disorders (involving dental pulp, periodontium, mucogingival tissues, and tongue), Cervical pain disorders, Sleep disorders (like sleep bruxism, obstructive sleep apnea), orofacial pain emanating from the sinus, heart, malignancies, Psychologic conditions like mood disorders and anxiety disorders. Depression, anxiety and prolonged negative feelings are common among chronic pain patients and may make persistent pain more difficult to tolerate or manage.
The general assessment of the OFP patient is aimed at identifying the what, where, how and why of the presenting complaint. Diagnosis of OFP requires taking a detailed history, completing a comprehensive clinical examination and ordering appropriate diagnostic tests of established validity. All dental patients should be screened for TMD’s and positive screening findings should prompt a more comprehensive evaluation. The OFP clinician must then synthesize the information to determine pain etiology and establishes a diagnosis. The immediate goal after establishing the diagnosis is to initiate a treatment plan.
Given the complex nature of OFP conditions, treatment should involve multiple modalities including pharmacologic therapy, oral appliances, physical therapy, trigger point injections, behavioral modification, diet and exercises that emphasize proper breathing and increasing flexibility.
OFP remains a prevalent and debilitating condition with significant social and economic impacts. Clearly the task required is the integration of knowledge in this anatomically dense region, traditionally divided between many medical disciplines. Based on extensive clinical experience with patients suffering from OFP and headache, an Orofacial pain clinician is well equipped to fulfill this task of giving adequate relief to an OFP patient and improving his/her quality of life.
