Orofacial Pain: The New Specialty

On March 31, 2020, the National Commission on Recognition of Dental Specialties and Certifying Boards (US) recognized orofacial pain (OFP) as the 12th specialty in Dentistry. Recognition of this specialty solidifies another link between dentistry and medicine, acknowledging that the orofacial region, oral cavity, and masticatory system are an integral part of total patient care.

Picture these scenarios:

Chronic pain that’s lasted for months after a dental surgery/procedure?
Ever felt that countless consultations/treatments never helped with your facial pain?
Headaches or pain on the back of your head that is affecting your normal life?
Sudden, severe facial pain that comes and goes... and you don’t know why!
Burning/ tingling/ stabbing/ electrifying pain that starts even with a whiff of cold breeze or light touch on your face?

Understanding Orofacial Pain

Orofacial pain, affecting millions globally, casts a long shadow over smiles. This diverse spectrum of discomforts encompasses the face, mouth, and jaws, significantly impacting daily life and well-being. From the sharp twinge of a toothache to the dull ache of TMJ disorders, understanding the intricate web of causes and navigating treatment options is crucial for regaining control and living a fulfilling life.

Unveiling the Culprits: A Closer Look

While dental culprits like tooth decay, gum disease, and abscesses remain top suspects, numerous other factors can trigger orofacial pain:

Temporomandibular Disorders (TMDs): Dysfunction in this crucial joint, responsible for jaw movement, can cause pain, clicking sounds, and difficulty chewing. Stress, injury, and misalignment are frequent contributors (National Institute of Dental and Craniofacial Research,
https://www.ncbi.nlm.nih.gov/books/NBK551612/).
Headaches and Facial Pain: Migraines, tension headaches, and cluster headaches can manifest as facial pain, ranging from throbbing discomfort to excruciating attacks (American Headache Society,
https://americanheadachesociety.org/about/special-interest-sections/trigeminal-autonomic-cephalalgias/).
Neuropathic Pain: Nerve damage due to shingles, trigeminal neuralgia, or injury can trigger burning, tingling, or shooting pain in the face and mouth (National Institute of Neurological Disorders and Stroke,
https://www.ncbi.nlm.nih.gov/books/NBK554486/).
Sinus Issues: Inflammation of the sinuses can radiate pressure to the face and teeth, creating a dull ache or throbbing discomfort (American Academy of Allergy, Asthma & Immunology,
https://www.aaaai.org/tools-for-the-public/allergy,-asthma-immunology-glossary/allergic-rhinitis-defined
Other Medical Conditions: Arthritis, fibromyalgia, and even psychological factors like stress and anxiety can contribute to orofacial pain, making diagnosis and treatment more complex (American College of Rheumatology,
https://rheumatology.org/patients/diseases-and-conditions).

Beyond the Obvious: When Orofacial Pain Masks Serious Illness

While the aforementioned causes are frequently encountered, orofacial pain can sometimes be a red flag for more serious systemic diseases. Recognizing these potential mimics is crucial for timely diagnosis and specialized treatment:

Trigeminal Autonomic Cephalalgias (TACs): This group of rare neurological disorders (including cluster headaches and paroxysmal hemicrania) can cause severe unilateral facial pain. Differentiating them from other headache types is crucial due to their specific treatment needs (American Headache Society,
https://americanheadachesociety.org/about/special-interest-sections/trigeminal-autonomic-cephalalgias/).
Giant Cell Arteritis (GCA): This inflammatory condition primarily affects the large arteries in the head, causing severe headaches, jaw pain, and scalp tenderness. Prompt diagnosis and treatment are critical to prevent permanent vision loss (National Institutes of Health,
https://www.ncbi.nlm.nih.gov/books/NBK459376/).
Multiple Sclerosis (MS): This autoimmune disease can affect the trigeminal nerve responsible for facial sensation and motor function. This type of pain arises from nerve damage and can manifest as burning, tingling, or shooting sensations. It is often described as "unrelenting" or "electric shock-like." This can be a crucial clue for early diagnosis (National Institutes of Health,
https://www.nccih.nih.gov/health/multiple-sclerosis).
Cancer: In rare cases, orofacial pain can be an early symptom of head and neck cancers, particularly affecting the trigeminal nerve. Thorough evaluation is crucial to rule out this possibility (National Cancer Institute,
https://www.mayoclinic.org/diseases-conditions/mouth-cancer/symptoms-causes/syc-20350997).
Other serious medical conditions that can masquerade as TMJ pain are: Rheumatoid Arthritis, Systemic Lupus Erythematosus, Ankylosing Spondylitis, Sjogren Syndrome, Polymyalgia Rheumatica, Chronic Fatigue Syndrome, Myofascial Pain Syndrome, Fibromyalgia.

Charting the Course to Relief: Exploring Treatment Options

Fortunately, a diverse armamentarium of treatments exists, depending on the underlying cause:

Pharmacological Management
Dental Interventions
TMJ Therapies
Neuromodulation Techniques
Surgical Interventions

Beyond Medicine: Embracing Self-Care Strategies

While treatments play a crucial role, managing orofacial pain extends beyond medications and procedures. Incorporating these self-care strategies can empower you to take control and improve your well-being:

Stress Management
Relaxation Techniques
Sleep Hygiene
Dietary Modifications
Heat and Cold Therapy

If you or anyone you know is suffering from chronic facial pain, do not consider yourself helpless. Through a comprehensive examination and analysis, I can help piece together the puzzle of your pain. I can then recommend appropriate treatment options or refer you to a specialist like, a neurologist in some cases, if needed. Time is of the essence, so do not delay any further.

Author

Dr. Arun Kalarikal is a highly experienced Cosmetic Dentist and DHA-licensed Implantologist with over 17 years of private practice experience. He holds a Fellowship in Orofacial Pain, TMD and Dental Sleep Medicine from Roseman University in the US and is currently pursuing his Master’s Degree in the same field. He is a leading Orofacial Pain Specialist skilled in diagnosing and treating face and jaw pain conditions through tailored and precise interventions.

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