Orofacial pain - assessment and treatment

The problem
Persistent face and mouth pain affects somewhere between 3% and 12 % of the population at any one time. The most common cause of pain within the oral cavity is toothache due to tooth infection or dental injury. The most common cause of facial discomfort is muscle pain, which may arise due to facial injury or excessive tooth grinding. Thankfully, standard toothaches and jaw muscle pains are easy to diagnose and respond quickly to treatment. On the other hand some patients experience excruciating pain in the orofacial region, which is difficult to diagnose. Some of these debilitating conditions are due to relatively rare disorders of nerves, blood vessels and bone. In other cases the severe pain may be due to unusual headache disorders or even pain referral from injury to the neck.

It is important to make the most accurate diagnosis possible based on information gathered from the history of the complaint, clinical examination findings and the results of xrays and other special tests. Apart from the basic physical examination, all possible aspects of the condition must be considered. This means that consideration is given to possible diseases of the nervous system, muscle and joint diseases, psychological influences and unusual headache disorders. There are some situations where patients are referred to specialist investigations like MRI or CT scans, blood tests, etc.

Treatment options for patients with chronic or severe oral and facial pain vary, from medication trials to nerve block injection to (occasionally) surgery. Even the most severe and intense pain problems may respond to the variety of treatment options now available in modern pain clinics.

Assessment picture -Dr Dermot Canavan, Orofacial Pain

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