Orofacial Pain Management

Orofacial Pain

Orofacial Pain (OFP) is the perceived pain in the face, jaw and oral cavity. OFP can extend or radiate into the throat, temples, behind the eyes, ears, back of head, neck and even the upper back. OFP is usually caused by localized disease or disorders of musculoskeletal and.or nervous systems which can refer pain to distant structures in the face/head/neck/upper back regions.

OFP creates a significant burden in terms of morbidity and health service utilization. OFP is estimated to affect up to 25% of the U.S. population on a daily basis with up 11% affected long-term.

Diagnosis and management of OFP has evolved over the past 50 years into a multidisciplinary specialty which overlaps dentistry oral medicine, Oromaxillofacial surgery orthodontics, otolaryngology, neurology, psychology/psychiatry/behavioral medicine, physical/rehab medicine/physiotherapy, pain medicine and sleep medicine.

The scope of Orofacial Pain specialists includes the diagnosis and management of, but not limited to:

  • Intraoral, Cranial and Systematic Disorders That Cause OFP
  • Complex Jaw and Cervical Muscle/Skeletal/Nervous System Pain and Dysfunction
  • Regional Neurovascular Pain Such As Headache Disorders That Include Orofacial Pain
  • Neuropathic Pain (Burning/Tingling/Shooting/Nerve Pain) In The Orofacial Area
  • OFP Related to Psychological/Psychiatric/Behavioral Disorders
  • Sleep Disorders Related to OFP
  • OFP Related to Systemic Disorders Such As Autoimmune, Rheumatoid Diseases, Cancer and AIDS
  • Orofacial Effects of Pain Syndromes Such As Complex Regional Pain Syndrome (CRPS)
  • Orofacial Movement Disorders Such As Dystonia, Dyskinesia and Nocturnal Bruxism/Jaw Clenching
  • Orofacial Aspects of Other Complex Multisystem Disorders Causing OFP and Dysfunction

Temporomandibular Disorders (TMD)

Temporomandibular Disorders (TMD) are a common subgroup of OFP and are often incorrectly referred to as "TMJ". TMJ is the commonly used abbreviation for the Temporomandibular Joint or jaw joint. The TMJ, like all joints in the body, can have numerous problems both intracapsular (inside) and extracapsular (outside) the joint. The nerves, blood vessels, connective tissue ligaments, capsule, collagenous disc, tendons, muscles and bones that form the TMJ complex, stabilize and hold the joint together, move the joint and stabilize the head when chewing occurs. These structures are subject to "wear-and-tear" and numerous medical disorders that affect all joints, leading to impairment and a variety of jaw/head/neck pain scenarios. A few of the common TMD scenarios include jaw pain/aching, ear pain/pressure/tinnitus, temple pain/headache (muscle tension and common migraine), retro-orbital (behind the eye) pain/headache, click/popping/locking/crepitus in the jaw joints, occlusal changes and tooth pain.

Temporomandibular Disorder Symptoms Include:

  • Headache
  • Earache
  • Jaw Pain
  • TMJ Noise (Popping/Clicking)
  • Abnormal Jaw Opening

An estimated 75% of the U.S. population has experienced one of more signs or symptoms of TMD. Most TMD symptoms are temporary and fluctuate over time, requiring little to no professional intervention. An estimated 5-10% of the U.S. population will require treatment. Like most chronic pain disorders, TMD usually involves more than a single symptom and really has s single causative factor. It is common for TMD to not only cause localized pain in the jaw joints, which usually increases with jaw functions but can involve pain in several other structures of the head, neck and upper back.

There are two basic types of Temporomandibular Syndromes:

Myogenous TMD

  • Extracapsular (Outside the TMJ)
  • Effects The Muscles, Tendons and Ligaments of the TMJ
  • Most Common Type of TMD
  • Often Reversible

Arthrogenous TMD

  • Intracapsular (Inside the TMJ)
  • Effects The Bones, Fibrocartilage and Synovial Lining of the TMJ
  • Often Caused by Acute Trauma to the Jaw

Otalgia (Ear Pain)

Otalgia is ear pain, commonly referred to as an “ear ache”. Primary otalgia exists when the pain originates within the ear. Referred otalgia is pain that originates outside of the ear. When primary otalgia is present, an ear examination typically shows some abnormality of the outer or middle ear. When referred otalgia is present, the ear examination is typically normal. Otalgia may or may not be associated with balance disorders and a reduction in hearing.

Common sources of primary otalgia include otitis media (ear infection), mastoiditis, tumors, trauma, and infections of the outer ear or ear canal, and Eustachian tube dysfunction, which is the inability for the middle ear to pressurize properly. Tumors of the temporal bone, such as meningiomas, glomus jugulare and some types of lesions such as cholesteatoma, have been associated with otalgia, possibly because of nerve root compression or invasion.