ORO-FACIAL PAIN
OROFACIAL PAIN
Diagnosis of Pain with no apparent dental cause clinically or radiographically, can only be made on the basis of
a detailed assessment of the character of the pain, including factors such as duration, site, periodicity, severity,
initiating and relieving factors.
Pain can be divided into those conditions in which the pain is episodic, constant, or is associated with loss of
function or sensation as summarised below.
Table 1. Pattern of pain.
Episodic Pain
Constant Pain
Loss of function or sensation
Trigeminal Neuralgia
Burning mouth syndrome
Facial nerve palsy
Glossopharyngeal neuralgia
Atypical facial pain
Trigeminal nerve paresthesia
Post herpetic neuralgia
Atypical odontalgia
Giant cell arteritis
Post herpetic neuralgia
Temporomandibular joint
dysfunction
Table 2: Episodic pain symptoms:
Trigeminal Neuralgia
Glossopharyngeal Neuralgia
Giant cell arteritis
Site
Face
Tonsillar region
Temple
Nature
Sharp, stabbing, shooting
Sharp, stabbing, shooting
Dull ache
Severity
Severe
Severe
Severe
Initiating factors
Light touch, washing
Swallowing, chewing
Eating
Relieving factors
None
None
None
Table 3: Constant pain symptoms
Burning mouth syndrome
Atypical facial pain
Atypical Odontalgia
Site
Mouth
Face
Tooth
Nature
Burning
Dull, boring ache
Dull boring toothache
Severity
Moderate to Severe
Moderate to Severe
Moderate to Severe
Initiating factors
None
None
None
Relieving factors
None
None
None
Psychological and psychiatric disorders can result in altered function of glandular function and parafunctional
oral habits. In addition antidepressant therapy disease and autoimmune diseases also affect salivary gland
function with consequent oral symptoms of halitosis, dryness, erythema, rampant caries all of which can be
managed clinically.
Causes of dry mouth: dehydration, anxiety, drug related therapy, immune related disease, systemic metabolic
disorders and developmental abnormalities.
Causes of Halitosis: Poor oral hygiene, dehydration, renal failure, respiratory tract infections, hepatic failure,
diabetic ketosis and delusional halitosis.
Causes of altered taste: All the above causes, neurological disease affecting the lingual nerve or intra-cranial
tumours.
The investigation of orofacial pain includes assessment for depression, endocrine disorders, renal and liver
function, function of peripheral and central nerve function as well as haematological disorders.
Temporomandibular joint dysfunction syndrome
Temporomandibular joint dysfunction syndrome is associated with occlusal abnormalities, lack of posterior
teeth, parafunctional clenching habits, nocturnal bruxism, anxiety and depression, or acute local trauma on
yawning or eating. TMJDS must be differentiated from structural TMJ diseases radiologically.
The management is in phases:
1. Dental:
Dental management would involve the use of antidepressant therapy for the atypical pain, provision of a night
guard to control the bruxism, the stimulation of saliva flow using chewing gum, sialoogues or artificial saliva in
addition to rigorous oral hygiene and preventive measures.
2. Medical:
Referral to a physician for full investigation and management of pernicious anaemia
3. Psychosocial:
psychosocial counselling