Orofacial Pain Treatment

What is Orofacial Pain?

Orofacial pain refers to pain associated with the hard and soft tissues of the head, face, and neck. Pain in the head and face, which can be very severe and debilitating causing considerable morbidity in general population. Orofacial pain often involves activation of trigeminal ganglion nerves and the development of peripheral and central sensitization.

Types of Orofacial Pain

Apart from dental/periodontal pain, temporomandibular joint disorders (TMDs) and atypical odontalgia, orofacial pain also includes the following

  1. Headaches-headache is pain or discomfort anywhere in the head or neck region. The pain originates from the tissues and structures surrounding the brain Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur. The pain may be a dull ache, sharp, throbbing, constant, mild, or intense

  2. There are three major categories of headache based on the source of pain:

    • Primary headaches, such as tension type, migraine and cluster headaches and other trigeminal autonomic cephalgias
    • Secondary headaches, such as injury related, due to infections or certain substances or their withdrawals
    • Cranial neuralgias, facial pain, and other headaches. Headaches may be caused by a number of conditions, such as disorders of the jaw, teeth, sinus, neck, eyes, brain, as well as an underlying condition such as brain tumors

    • TMDs and Headaches

    • Recurrent headache may occur in as many as 80% of TMD patients. These types of headaches are modified with jaw movement, function, or parafunction
    • Headaches can be occasional, recurrent or chronic in frequency. Common treatments of headache include recognition and avoidance of the triggers that initiate headache, addressing any underlying causes such as TMD and neck pain, lifestyle changes, medications, and Botox

  3. Heterotopic pain
    • Patients often describe the site of the pain is not in the same location as the source of the pain
    • For example, cardiac pain could result in jaw pain. When an individual experiences angina/heart attack, the site of pain is frequently in the mandible, shoulder, or radiating down the left arm
    • In these conditions, it is important to identify the correct source of pain to alleviate pain experienced by the patient

  4. Post-herpetic neuralgia
    • Post-herpetic neuralgia is a dermatomal disease persisting beyond 3-4 months after the acute Shingles attack
    • a burning sensation with episodic "stabbing" pain
    • It could also result in sensitivity of teeth of the affected side that are easily confused with dental infections
    • Shingles vaccine is considered the most effective way to reduce incidence of herpes zoster and post-herpetic neuralgia

  5. Trigeminal Neuralgia
    • Trigeminal Neuralgia (TN) is a neuropathic disorder that often appears suddenly as a sharp, shooting pain lasting a few seconds and can be triggered by a touch or a slight movement in a specific area
    • This neuralgia of the fifth cranial nerve is triggered and produces a sharp pain likened to an electric shock; it can last seconds to minutes, with pain-free intervals
    • Secondary forms of trigeminal neuralgia may be seen in patients with disorders such as multiple sclerosis and nerve compression owing to tumor or vascular abnormalities

  6. Glossopharyngeal neuralgia
    • It is a rare condition that affects the ninth cranial nerves/li>
    • The episodic pain in this unilateral neuralgia is sharp, lancinating (jabbing) stabbing, and extremely intense
    • Patients often feel a scratching or foreign body sensation in the throat

  7. Cancer, autoimmune diseases, multiple sclerosis, sickle cell anemia and salivary gland dysfunction represent the diagnostic range for the complaint of orofacial pain

  8. Psychophysiologic
    • Psychophysiological disorders are physical disorders with psychological issues
    • Psychophysiological models of chronic pain conditions focus on the role that psychological and psychosocial stressors play in muscular pain and spasm

How is Orofacial pain treated?

  • Patients with Orofacial pain often visit many doctors and undergo numerous tests, and often fail to reach a definite diagnosis for their symptoms
  • A careful history accompanied by a comprehensive examination which includes a thorough history, examination, and diagnostic tests is required to determine the correct diagnosis
  • The history includes recording the exact nature of the pain (the timing, duration, quality, and intensity of pain) and other symptoms you may have, the history leading up to the persistent pain, previous doctors seen, past treatments and their results, and a list of medications taken with their effectiveness and side effects
  • Social history (including major life events) and psychiatric history is also important; specifically, regarding treatment for anxiety, depression, and panic attacks, all of which can be associated with chronic pain conditions
  • Dr. Saini's examination will consist of touching different areas of the head, neck and inside the mouth, measurements and evaluation of the jaw, head and neck, and gentle provoking of the pain. This is performed with light touches, heavier touches cold or heat (Qualitative and Quantitative Sensory Testing). Some simple neurological tests are performed to test the cranial nerves
  • Other diagnostic tests such as imaging/blood work might also be required
  • After analyzing the results of the history, examination, and diagnostic tests, Dr.Saini will suggest a diagnosis and recommend appropriate treatment strategy
  • Often several treatments may be attempted before an effective approach for pain control is found
  • Nonpharmacologic methods of coping with pain such as cognitive behavioral therapy, mindfulness, relaxation techniques, biofeedback, etc. and multidisciplinary approach may be required
  • Treatment of chronic orofacial pain disorders often requires considerable patience to eventually control the pain
  • Patients receiving ongoing treatment need be monitored closely to provide the greatest chance of a successful outcome

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Surrey Office

Phone: (604) 498-0100

Phone: (604) 498-0100

Fax: (604) 498-0244

Email: info@blissoralwellness.ca

Address: 9655 King George Blvd. Unit # 170 Surrey, B.C. V3T 0C7

The clinic is located just across Surrey Memorial Hospital on King George Blvd. and 96th Avenue.

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Phone: (604) 336-7411

Phone: (604) 336-7411

Fax: (604) 336-7412

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Phone: 250-586-9995

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Email: oralmedicinenanaimo@blissoralwellness.ca

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Phone: 250-590-5932

Phone: 250-590-5932

Fax: 604-336-7412

Email: oralmedicinevictoria@blissoralwellness.ca