Orofaci pain

• Pain

  An unpleasant emotional feeling due to either physical or psychological trauma
• Pain


  • It is a subjective symptom usually initiated by a noxious stimulus (that injure or threaten to destroy the tissue) and transmitted through a specialized neural network to the central nervous system, where it is interpreted as pain
• Acute pain


  Short duration, moderate to severe in severity and may be not relief by mild analgesics
• Chronic pain


  Long duration (4 to 6 months), mild to moderate in severity and is often associated with feelings of depression (attention to psychological influences)
• Classification of Orofacial Pain

  • Typical Orofacial Pain
  • Psychogenic Orofacial Pain
  • Vascular Orofacial Pain
  • Neuralgia
  • Other Orofacial Pain (Referred pain)
• Typical Orofacial Pain


  • Dental
  • Periodontal
  • Mucosal
  • Bone
  • Salivary gland
  • Temporo-Mandibular Joint
  • Maxillary sinus
• Psychogenic Orofacial Pain


  • Facial arthromyalgia
  • Atypical facial pain
  • Atypical odontalgia
  • Oral dysthesia
  • Factitious ulceration
• Vascular Orofacial Pain


  • Migraine
  • Cluster headache
  • Giant cell arteritis
• Neuralgia

  • Primary neuralgia
  • Secondary neuralgia
• Primary neuralgia

  • Trigeminal neuralgia
  • Glossopharyngeal neuralgia
• Secondary neuralgia


  • Extra cranial lesions
  • Cranial base lesions
  • Intracranial lesions
• Extra cranial lesions

  • Two mental nerves neuralgia
  • Causalgia
  • Frey's auriculotemporal syndrome
  • Herpes zoster
  • Post herpetic neuralgia
  • Nasopharyngeal carcinoma
• Cranial base lesions

  • Petrous Temporal osteitis
  • Cholesteatoma
• Intracranial lesions

  • Posterior cranial fossa
  • Middle cranial fossa
  • Multiple sclerosis
• Other Orofacial Pain (Referred pain)

  • Ocular
  • Cardiac
  • ENT
  • Elongated styloid process
• Painful disorders of the maxillofacial region, whether neurologic or musculoskeletal, are common reasons for obtaining a dental opinion
• It is critical for dentists to become knowledgeable about facial neuropathologic conditions
• The different structures in the head and neck region (e.g., eyes, ears, salivary glands, muscle, joints, sinus membranes, intracranial blood vessels) make an accurate diagnosis challenging
• Diagnosing pain

  1. Take history carefully if no detectable sign of disease

  2. Send patient for more laboratory investigations if there are associated signs
• Visual Analogue Scale and Verbal Rating Scale


  Methods used to document the symptoms severity described by the patient and use this to achieve classification of pain severity and disease control
• Information to take in the history

  • Character of the pain
  • Severity of the pain
  • Site at which it felt and any pain radiation
  • Timing: frequency and duration of subsequent attacks
  • Provoking factors
  • Relieving factors
  • Associated clinical features
  • If the patient suffers from pain elsewhere in the body
  • General medical history
  • Patient's emotional history
  • Family history
• Somatic pain


  Arises from musculoskeletal or visceral structures interpreted through an intact pain transmission and modulation system
• Neuropathic pain


  Arises from damage or alteration to the pain pathways, most commonly a peripheral nerve injury due to surgery or trauma
• Psychogenic pain

  Tension headache occurs as a result of stressful life, anxiety, neurosis or depression
• Typical Orofacial Pain


  • Dental pain (odontalgia)
  • Periodontal pain
  • Mucosal pain
  • Bone pain
  • Salivary gland pain
  • Temporo-Mandibular Joint pain
  • Maxillary sinus pain
• Dental pain (odontalgia)


  Pulpitis presented as transient dull or sharp pain provoked by thermal changes, may be well localized but occasionally becomes diffuse or referred to the opposite tooth
• Treatment of dental pain

  Amalgam or composite filling, RCT, or extraction of unrestorable tooth
• Periodontal pain


  Periodontitis presented as continuous dull pain initially relieved by clenching the teeth, but later on is aggravated by this action, associated with gum recission, exposed root, pocket, or tooth mobility
• Treatment of periodontal pain

  Acute periodontal abscess treated by drainage of exudates and antibiotic, after that periodontal surgery (root planning and curettage) when the acute phase has been subsided
• Mucosal pain


  Traumatic ulceration, aphthous stomatitis, viral ulceration, erosive lichen planus, etc, which may involve the oral mucosa, causing burning sensation which is provoked by spicy or hot food
• Investigation and treatment of mucosal pain

  Biopsy if ulcer persists for more than two weeks, each condition requires specific therapy
• Bone pain


  Alveolar osteitis (dry socket), fracture, osteomyelitis and tumor causing bone pain which is vary from continuous dull ache to a severe throbbing
• Investigation and treatment of bone pain

  1. ray and biopsy, Analgesic and antibiotic or surgery
• Salivary gland pain


  Diseases of the salivary glands such as sialadenitis, obstructed duct, mump and tumors presented as well localized intermittent dull pain and associated with a swollen gland and xerostomia
• Investigation and treatment of salivary gland pain

  Plain radiography or sialography, each condition requires specific therapy
• Temporo-Mandibular Joint (TMJ) pain


  Traumatic arthritis of TMJ: moderate to severe pain, well localized and aggravated by mandibular movements and tender joint on palpation

  Osteoarthritis of the TMJ: well localized to the affected joint, provoked by jaw movements and there is tenderness and audible crepitus (clicking) in the joint
• Investigation and treatment of TMJ pain

  1. ray (TMJ, PA, OPG views or MRI), Conservative therapy, resting the joint and analgesics, Correction of the occlusion, Ibuprofen 400 mg t.i.d., arthrocentesis, Intracapsular injection of 1ml Dexamethasone or smoothing of the condylar head by open surgery
• Maxillary sinus pain


  Sinusitis presents as dull or severe maxillary pain, either unilateral or bilateral which is become worse on head bending
• Investigation and treatment of maxillary sinus pain

  1. ray; Occipitomental view reveals radioopaque sinus, Antibiotic, analgesic, nasal decongestant, or surgery
• Facial arthromyalgia (TMJ Myofascial Pain Dysfunction Syndrome)


  The condition may vary from clicking of the joint on chewing or talking to a severe continuous ache in one or both joints, and the pain may radiate to the temporal, occipital regions, or angle of the mandible. Tenderness in the TMJ and muscles (temporalis, masseter, medial & lateral pterygoid). The patient may also has accompanied pain in other body sites as cervical pain and irritable colon, etc.