Orofacial pain is a complex topic for patients to address, as the sources of their pain can come from complex disorders and diseases. Orofacial pain as a concept exhibits similar symptoms, but the pathology of this pain can result from different regions of the mouth, jawbone, or other areas of the body and can ultimately determine treatment. For endodontists, addressing orofacial pain revolves around diagnosing its pathology, diagnosing the condition, and managing the condition with long-term treatments.
What Defines Orofacial Pain In Endodontics?
Orofacial pain consists of a specific collection of diseases and conditions that exhibit similar symptoms. As a catch-all term, orofacial pain is complex, and to further expand on what pathologies ultimately contribute to this condition, endodontists need to determine whether or not the condition is odontogenic and non-odontogenic, or whether or not the orofacial pain results from the teeth and dental tissues or from other regions of the mouth. In regard to orofacial pain from an odontogenic origin, examples of this can include dental tumors, abscesses, cavities, and gum disease. Once the origins of orofacial pain move beyond odontogenic origins, other regions of the body need to be considered.
Orofacial pain can also result from complex areas of the neurovascular, neuropathic, and musculoskeletal systems. Orofacial pain that results from these sources tends to require more interactive engagement with other specialties, such as neuropathologists and orthopedists. Orofacial pain from a non-odontogenic origin can include a variety of sources, including:
- Neurovascular Disorders: Typical neurovascular disorders, including migraines, cluster headaches, and tension headaches, can often lead to orofacial pain due to the intensity of their symptoms, which include seeing auras, sensitivity to moving lights, and frequent nausea.
- Neuropathic Pain Disorders: Neuropathic conditions, including rarer ones such as trigeminal neuralgia, can cause shock-like pain sensations to the nerves and limit their function, and sometimes that nerve pain can navigate to the facial areas and cause orofacial pain.
- Temporomandibular Disorders: Temporomandibular disorders, unlike TMJ disorder, encompasses a larger category of pain sensations surrounding the jaw and the jaw joints and can directly cause orofacial pain.
- Burning Mouth Syndrome: Burning mouth syndrome is a specific condition that often results from nerve damage surrounding the facial muscles and can immediately contribute to orofacial pain. However, this condition can also be caused by decreased saliva production, medication usage, and even systemic diseases such as diabetes.
- Neck and Spine Injuries: Injuries to the neck and spine can also cause orofacial pain, affecting the nerves, muscles, and ligaments.
- Dyskinesia and Dystonia: Muscle movement conditions that are involuntary and erratic around the face can also cause orofacial pain due to the intensity and frequency of these spasms.
- Sleep Disorders: Some disorders such as bruxism and mouth clenching will often cause orofacial pain as well as sleep apnea and other breathing problems.
- Trauma: TMJ disorders that develop from traumatic experiences and accidents that injure the facial areas can lead to long-term facial pain.
How Endodontists Diagnose Orofacial Pain
To truly work at diagnosing and treating orofacial pain, endodontists have to work at taking a multi-disciplinary approach. Through specific protocols in caring for patients with orofacial pain, properly diagnosing this type of pain takes looking at whether or not the pain is sourced from the endometrium area rather than other sources such as the jawline, nerves, or spine.
However, to further look into and diagnose orofacial pain, the type of pain experienced can also be narrowed down to types such as:
- Odontogenic Pain: Odontogenic pain refers to pain arising from areas such as the teeth, periodontal regions, and pulpal areas, and most often consist of conditions such as necrotic gingivitis and infected pulpitis.
- Non-odontogenic Pain: Unlike odontogenic pain, non-odontogenic pain occurs in the intraoral areas but specifically focuses on gums and cheek lining, and conditions such as mouth ulcers, oral mucositis, and burning mouth syndrome account for this type of pain.
- Heterotopic Pain: Heterotopic pain is pain that, while experienced in the perceived region, comes from a completely different source. This type of pain is more common and can make the diagnosis process difficult.
- Nociceptive Pain: Nociceptive pain, known as somatic pain, specifically refers to the nervous system and how that system reacts and responds to pain signals. A localized sensation of pain in the orofacial area can be exhibited from areas outside of the nervous system and typically cause reactions when interacted with.
- Non-nociceptive Pain: This type of pain, also known as neuropathic pain, circulatory malfunctions occur and set off false alarms throughout the nervous system and thus create sensitivities and symptoms of pain in the facial area, with conditions such as migraines and neuralgias.
Endodontists in these situations work to diagnose these various types of pain through observing their patient’s medical history and using diagnostic tools such as x-rays, CT scans, and observing family history can help. However, implementing long-term management techniques and treatments for orofacial pain is what we can provide to help patients.
Helping Patients With Long-Term Dental Care
Most of all, discussing with patients about their conditions and finding treatment that works for them is ultimately the best way towards finding solutions that help them heal from orofacial pain. In endodontic practices, this also means cooperating with their primary care providers and providing referrals to other specialties that can help further address their pain on a more interactive level. However, with specific cases where the endometrium is effective, methods such as medications, exercises, prosthetic devices, and restorative treatments can help address the source of pain on a more integrated level.
Overall, chronic orofacial pain brings out highly challenging scenarios for endodontists, but once the orofacial pain is defined and properly diagnosed, then the right treatment can be made to help soothe this pain. From there, more specialized treatment can be made through long-term care, follow-up appointments, and, most of all, a compassionate disposition towards patients and their conditions. Proper diagnosis is essential for high-quality care, and understanding how orofacial pain can manifest can help patients better comprehend their treatments at the office.
