Orofacial pain is common in much of the population, but the complex ways in which it presents and the numerous causes that exist make it difficult to diagnose and effectively treat. Pain can present in many different areas and with distinctly different sensations, yet still be considered “orofacial pain,” meaning that effective management usually comes down to a multidisciplinary approach—often with multiple doctors specializing in different areas of expertise.
For example, pain can come from decay or infection of the teeth and gums, which might require dental surgery; or maybe the muscles around the jaw are tense, which would warrant a behavioral modification approach to stress management. As mysterious as the condition can be, experts have identified the most common types of orofacial and atypical facial pain, as well as the most effective treatments to improve symptoms and quality of life for patients who are suffering.
Identifying Orofacial Pain
Orofacial pain is most commonly defined as pain in the mouth, face, jaw, or head. The condition is usually chronic and can range in severity from mild to debilitating. Once a patient begins exhibiting symptoms, a full medical evaluation is usually required to better understand the nature of the pain. Specialists will usually start by examining structures in the jaw and face for obvious malformation or asymmetry, as well as dental and oral health. They might look for swelling or discoloration in the skin to indicate soft tissue disorders, or listen for popping, clicking, or cracking sounds in the jaw or neck during normal mobility.
Finally, they may ask questions like: When did the pain start? Do you notice it happening at certain times of the day or night? Have there been any major changes to your life or daily routine? Have you suffered any injuries or other physical conditions in the mouth, face, or head?
it’s crucial to understand the co-existing factors like psychiatric, psychosocial, or other health disorders to best diagnose the kind of pain the patient is experiencing. Migraines, for example, have many different causes—from atypical jaw alignment to potential neurological conditions like tumors or cancer. Evaluation at a specialized orofacial pain clinic gives patients the best chance at accurate identification and diagnosis of their pain, leading to more effective treatment.
Common Causes of Orofacial Pain
Once symptoms, co-existing factors, and a general timeline have been established, a specialist can better posit a formal diagnosis. The most common type of orofacial pain usually comes from a previous injury or infection which can cause lasting trauma to the nerves (of which there are many) or other structures in the face, jaw, and head. Pain from physical trauma is usually easier to spot and has clearer treatment methods than atypical pain from neurological or psychosocial causes.
Common Types of Orofacial Pain
To better understand the causes of orofacial pain, it helps to understand how orofacial and atypical pain is categorized. Experts have identified several common types of pain and where in the body they might originate
Musculoskeletal conditions involve improper function or inflammation of the muscles in the jaw, neck, or face, and are one of the most common conditions that patients seek treatment for. Perhaps the most well-known orofacial pain condition in this category is Temporomandibular Joint Disorder—commonly called TMD or TMJ.
Your temporomandibular joint is the main hinge that allows your jaw to open and close, and disorders are often characterized by clicking, popping, or locking sensation in the jaw when eating, talking, or opening your mouth especially wide. Many different factors can affect the operation of this joint, including stress, physical trauma, poor posture or oral habits, etc., which makes TMJ treatment challenging at times. TMJ mistaken for toothache or other dental conditions is also a common misdiagnosis.
Pain that originates or is caused by problems with the teeth or gums is referred to as odontogenic pain and is among the easiest orofacial pain conditions to identify and treat. Patients presenting with odontogenic pain will often have identifiable decay or trauma in the mouth, which—if left untreated—can compromise other structures in the mouth leading to pain that spreads beyond just a singularly affected tooth. In some instances, decay or infection in the tooth can spread to the nerve endings in the jaw causing radiating pain, burning, or throbbing.
Vascular conditions such as migraines and headaches can sometimes present as orofacial pain due to the disturbance of the trigeminovascular system that encompasses most of the head. Migraine symptoms can cause pain behind the eyes, forehead, and the sides of the head, yet the causes and exact anatomy of why do we feel pain from migraines are still not entirely understood.
Neuropathic orofacial pain is an atypical orofacial pain that can come from different conditions that may only affect the face or potentially the entire body, like fibromyalgia. These conditions affect the nerves and pain pathways in the body and are usually classified as episodic and continuous. Conditions like atypical odontalgia, for example, inflame the nerves around the tooth and can result in a lancing, or electrifying feeling around the affected area.
How is Orofacial Pain Treated?
While orofacial pain is a complicated and multifaceted problem, there is evidence to suggest that many conditions will improve on their own over time or with minimally invasive treatment, meaning that a conservative approach is ideal and, more often than not, effective. Treatment of pain usually is decided by the type of pain a patient is experiencing.
Mild TMJ, for example, can be treated with musculoskeletal therapy like ice, rest, and over-the-counter medication to control inflammation. Because there may be psychological components to TMJ like stress or anxiety that cause a patient to involuntarily tense the muscles in the neck, face, or jaw, a specialist might also order cognitive therapy or behavioral modification practices to treat the underlying mental issues.
Odontogenic pain can usually be treated with dental procedures ranging from simple fillings to root canals or, in certain cases, extractions. Often simply treating the affected tooth can relieve the accompanying pain, but there are cases where lasting symptoms can still impact patients’ quality of life. These, and more atypical causes like vascular or neuropathic pain, can require specific medication to manage symptoms, as well as potential lifestyle changes to avoid triggering episodic or conditional pain.
In most cases, surgery and other more invasive options are usually only considered as matters of last resort. Potential complications or other risk factors are always part of a surgical treatment route, but our team of orofacial surgeons has excellent results in helping patients live better pain-free lives. For more information on the causes and treatments of orofacial pain, including TMJ treatment in Reno, contact our office to make an appointment for an initial consultation.