FAQ
Orofacial Pain
Orofacial Pain is the specialty of dentistry that encompasses the diagnosis, management andtretment of pain disorders of the jaw, mouth, face, head and neck.
An Orofacial Pain specialist must be educationally qualified by completion of an educational program of two or more years accredited by the Commission on Dental Accredtation (CODA) of the American Dental Association and board certification by the American Board of Orofacial Pain.
The most common pain in the mouth is dental pain. The most common pain in the face is muscle pain. When an obvious cause is not present, pains are generally classified as: neuropathic pains (related to nerves, such as a neuralgia), neurovascular pains (related to nerves and blood vessels, such as a migraine) and musculoskeletal pains (related to muscle and joints, such as TMJ and neck problems). The following information summarizes these types of disorders, their origins and symptoms.
Neuropathic Pain
Neuropathic pain refers to pains originating in the central (brain and spinal cord) or peripheral (nerve fibers) nervous system. Most of us are familiar with an injured body part sending signals along a healthy nerve to tell us that the body part hurts. In neuropathic pain, the problem lies within the nerve itself, telling us that a healthy body part hurts. Therefore, it can be very frustrating for a patient experiencing severe pain while everything appears to be healthy. Neuropathic pains are often accompanied by complaints of burning, stinging or shocking sensations, and sometimes mechanical complaints, such as intense squeezing or pulling.
In some cases, neuropathic pain may develop after a dental procedure cuasing confusion for the dentist and the patient.
Neuralgia refers to pain along the distribution of a nerve. Trigeminal neuralgia is a unique type of nerve pain with specific characteristics. The facial pain is characterized by spontaneous, brief episodes of electric shock-like pains limited to the distribution of the involved branch of the nerve. Pain may be triggered by light touch in a " trigger zone" usually along the same nerve distribution as the pain. It may also occur spontaneously. The paroxysms (volleys) of pain usually last from seconds to minutes.
The trigeminal nerve is the major sensory nerve to the face and head. It has three branches and the pain may be in one or more branches of the nerve. Most often the pain is on one side of the face only.
Many neuralgias exist and may be named for the involved nerve such as glossopharyngeal neuralgia (one of the sensory nerves of the tongue and throat) or occipital neuralgia (a sensory nerve at the base of the skull and back of the head). It is important to note is that two forms of neuralgias exist: paroxysmal (episodic) and continuous. Paroxysmal neuralgias are intense, often electric, pains that come in brief volleys (seconds to minutes in duration). An example of a paroxysmal neuralgia is trigeminal neuralgia, which is described above.
Continuous neuralgias are usually less intense and are often described as constant burning and aching, sometimes with episodic shooting pains. An example of a continuous neuralgia may follow shingles and is called post herpetic neuralgia. Continuous neuralgias may be extremely difficult to diagnose and treat, as many causes can be responsible for the nerve dysfunction. In contrast to paroxysmal neuralgias, continuous neuralgias in the head and face may affect both sides of the head and face. Characteristic of continuous neuralgias is that the site of pain often involves a larger area than the distribution of the involved nerve. Frequently patients complain of extreme sensitivity to touch or temperature, and their pain may be much worse than one would expect from an obvious injury.
Continuos or episodic neuralgias can occur after dental treatments.
Neurovascular Pains
Primary headaches are headaches that have no other known cause for the pain such as fever, trauma or tumor. The most common primary headaches are migraine and tension type headaches.