MUSEUM DENTAL CENTER
Los Angeles Orofacial Pain and TMJ Center
Pain felt in a tooth might not be coming from the aching tooth. Dr. Khalifeh, an Orofacial Pain Specialists is here for you to help you avoid unnecessary dental work and save you months or years of suffering and frustration!
Orofacial Pain Disorders
“Orofacial pain disorders” is a broad term used to describe symptoms of pain and/or dysfunction in the head and neck region.
What are Common Causes of Orofacial Pain?
Multiple causes for orofacial pain include:
1. Bite problems.
2. Psychological stress.
3. Trauma to the jaw and head.
4. Bruxism (clinching and grinding of the teeth).
5. Neurological conditions such as neuralgias.
6. Auto-immune disorders such as multiple sclerosis.
7. Vascular problems such as stroke.
8. Hereditary conditions like migraine headaches.
9. Infection such as post herpetic neuralgia and others.
10. Tumors and cancers in the head and neck regions or metastasized lesions form other body regions.
11. Iatrogenic illness caused during surgical procedures or as side effects to some prescription medications.
Orofacial Pain disorders are very common and debilitating conditions. However, the pain may be felt in your teeth and face despite being caused by from other areas of the head. A 2002 a study on Orofacial Pain found that highest prevalence was for pain caused by opening the mouth (21%-49%), muscle tenderness (17%-97%) and joint pain (5%-31%). (3)
What are the common symptoms of Orofacial Pain Disorders?
In list format, the common symptoms of Orofacial Pain are:
Clicking, popping, or locking in the Temporomandibular joints (TMJ).
Ear pain, ringing in the ears, or ear fullness.
The oral cavity and facial structures have close associations with daily functions of eating, communication, vision, and hearing as well as appearance, self-esteem and personal expression. This is why, persistent pain or disease in this area can deeply affect an individual both psychologically and physically.
How Prevalent is Orofacial Pain?
Orofacial pain is a common problem.
In the United States, the Oct 27, 2017 NIH Orofacial pain – an update on diagnosis and management report estimated that 22% of the general population had suffered from some form of facial pain at some point in the 6-month period before questioning, of which 12% was toothache.
Patients with TMJ and Orofacial pain have been neglected for years because their condition falls between medicine and dentistry. As a result, they are often subjected unsuccessful trial and error treatment without resolution of their pain. Another problem facing patients who suffer from Orofacial pain conditions is that this condition is often not covered by either medical or dental insurance plans.
The anatomy or the human body is crafted so there is more sensory innervation in the face and oral cavity than in any other region of the body. A national poll found more adults working full-time miss work from head and face pain than any other site of pain.
After that, specialty recognition of Orofacial Pain was an important milestone for all patients who suffer from these disorders. Now these patients now know where to turn to receive high quality and successful care. Additionally, these well-trained specialists are recognized by both Medicine and Dentistry (3).
How are Orofacial Pain Conditions Diagnosed?
Diagnosis of Orofacial pain can be difficult, as it may require multiple examinations and medical histories provided by the patient. However, the pain history is essential and will indicate any further examinations required.
A patient might experience pain in one area while the source of the pain is in another area. However, the diagnosis usually relies initially on the patient’s history. During diagnosis of Orofacial Pain conditions patients will be asked to fill a comprehensive health history form. Additionally, patients will answer questions about their chief complaint, history of present illness, systemic health conditions, medications, allergies, hospitalization, surgeries, family history, social history and psychological history.
After that, physical and neurological evaluation will be performed, including taking the vital signs. Clinical evaluation of the head, neck, shoulder and Orofacial regions will also be performed. Any abnormality or deviation will be reported. Additionally, patients’ 12 cranial nerves will be evaluated as well.
What diagnostic tools are used to diagnose Orofacial Pain?
The following are typical diagnostic tools that may be used to help reach the correct diagnosis:
Digital imaging (X-Rays).
CT scan of the head and neck region or part of that region.
MRI of the head and neck, the spinal cord and the brain.
Drug injections or infusion for diagnostic purposes.
What Common Treatments are used to Relieve Orofacial Pain?
Treatment of Orofacial pain conditions is dictated by the type of problem each patient is experiencing. Therefore, there is no one treatment that fits all conditions. One or more of the following treatment options might be used to help reduce the suffering of patients with this condition.
Treatment and remedies for Orofacial Pain Disorders may include:
Self-management and exercises.
Anti-inflammatory drugs (steroidal and NSAIDS).
Trigger point injections.
Steroid or Hyaluronic acid joint injection.
Arthrocentesis of the joint.
Acupuncture and dry needling.
Pain modulating drugs such as TCA anti-depressants.
Medications including the triptans, antidepressants, anticonvulsants, muscle relaxants and the recently FDA approved medications including some DMARDS and CGRP antagonists.
What is the Long-term Outcome of Orofacial Pain Disorders Treatment?
Clinical trials and systematic reviews have shown that the long-term outcomes of patient-centered rehabilitation approaches may prevent long-term chronic pain, addiction, and disability in nearly every patient. Patient-centered approach include using splints, exercise, physical therapy, cognitive-behavioral training, mindfulness, and relaxation
Orofacial pain specialists provide evidence-based treatments to improve Orofacial pain conditions. It may also be central to your restorative dental plan. We strive to prevent chronic pain and addiction while helping the health care system prevent the devastating escalation to chronic pain and addiction. See our case studies below.
How do I find an Orofacial Pain Specialist?
Unfortunately, access to care for patients with these disorders is often difficult because the limited number of Orofacial pain specialists and the fact that the care often lies within both medicine and dentistry. A survey of 405 health professionals in the Midwest found that 90% of health professionals would refer to an Orofacial pain dental specialist if there was one available (4).
Orofacial pain specialists form a patient-centered pain management program to both treat the conditions and address the many contributing factors that drive chronic pain, addiction, disability, and ongoing dependency on the healthcare system. The pain specialist may work with a team.
Your care may include a physical therapist to improve the musculoskeletal function. Also, it may include a pain coach to support self-care changes and a pain psychologist to provide counseling for depression and other psychosocial factors that complicate pain might be added to the treating team. It also often involves other health professionals including the patient’s primary care dentist, physician, and a physician pain specialist to diagnosis and manages common widespread pain conditions such as fibromyalgia.
In-office Cases Museum Dental Center Treats
TMJ disorders, locked jaw, painful clicking jaw, dislocated jaw, etc.
Headache conditions including tension type headache, migraine, cluster headache, chronic paroxysmal hemicranial, hemicranial continua and other TMD related headache.
Neuralgias in the head and neck region.
Masticatory muscle disorders and pain including myalgia and myofascial pain.
Bruxism, teeth grinding, clinching and related problems.
Other orofacial motor disorders such as dystopia and dyskinesia.
1. Hargreaves KM, Cohen S, eds. (2010). Cohen’s pathways of the pulp. Berman LH (web editor) (10th ed.). St. Louis, Mo.: Mosby Elsevier. p. 50. ISBN 978-0-323-06489-7.
2. Macfarlane, T. V; Glenny, A-M; Worthington, H. V (2001-09-01). “Systematic review of population-based epidemiological studies of oro-facial pain”. Journal of Dentistry. 29 (7): 451–467. doi:10.1016/S0300-5712(01)00041-0. ISSN 0300-5712. PMID 11809323.
3. Dr. James Fricton, pain specialist at MN Head & Neck Pain Clinic and Chair of the Orofacial Pain Specialty Committee.
4. Look, J and Fricton, J Access to care for patients with orofacial pain: A survey of dentists. AAOP newsletter, 1999
Need more information about Orofacial Pain Disorders? Visit the American Academy of Orofacial Pain (AAOP).
Orofacial Pain Case study
Case Report 1:
A lady in her 70s, presented with pain on one of her lower front teeth for the last few weeks. The pain is moderate to severe in intensity that is always present. Sometimes the pain is sharp, shooting pain that is stimulated by biting and chewing food. However, over the counter pain medications including Advil and Tylenol were not helping.
Clinical and radiological examination revealed gum infection and some bone loss associated with the painful tooth. The area was cleaned well and irrigated using oral antiseptic solution. Additionally, antibiotics was prescribed for 5 days. We asked the patient to come back for check-up after a week.
On check-up appointment, there were no improvement. The gum infection was no longer there. Dry ice test for the teeth was equivocal. Anesthetic test using local anesthesia injection didn’t help the pain.
Based on the history and clinical evaluation, an initial diagnosis of neuropathic pain was made. For insurance purpose, I referred the patient to a neurologist in her insurance network. I stated in my referral letter my preliminary diagnosis and suggested that the patient get a brain MRI to exclude brain lesion. The MRI was negative.
The neurologist agreed with my diagnosis and placed the patient on special medication for neuropathic pain. Patient’s symptoms improved and the pain was gone in few days after using the new medication.
The final diagnosis for this case was Atypical Trigeminal Neuralgia, a condition that is rarely presented as a tooth ache.
This patient was very lucky to be seen by an Orofacial pain specialist at an early stage. Cases like this patient usually suffer for many years before being correctly diagnosed and treated. Furthermore, they usually get several root canals, surgeries, dental extractions, dental implants and other treatments without getting pain relief.
Case Report 2:
Mr. W.B. had a very bad weekend. He had severe pain on his lower right last molar. The pain was so bad that he was not able to sleep. He asked for root canal treatment on the painful tooth.
A thorough evaluation of Mr. W.B.’s condition revealed that the pain is referred from an active trigger point in the patient’s right masseter muscle. The tooth where he feels the pain was actually healthy.
A trigger point injection to the right masseter muscle using local anesthesia gave the patient instant and lasting pain relief without the need for root canal or any other dental treatment.
However, one research study revealed that 17% of teeth pain is pain from the jaw muscles. Mr. W.B. was very happy with the treatment outcome.
If you or anyone you know is suffering from TMJ pain or dysfunction in the Orofacial region, do not hesitate to contact Dr. Khalifeh, he is an Orofacial Pain specialist certified by the American Board of Orofacial Pain.
Schedule an Appointment with Los Angeles Orofacial Pain Specialist, Dr. Khalifeh
Dr. Mohammad Khalifeh, DDS, MS. Is board-certified Orofacial Pain and TMJ specialist. He is a Diplomate American Board of Orofacial Pain. Above all, Dr. Khalifeh is TMD and Orofacial Pain Board Certified doctor. Additionally, for over 26 years, Dr. Khalifeh is helping patients with TMJ and jaw pain in Los Angeles, Miracle Mile, Park La Brea, Beverly Hills, Larchmont Village, Hollywood, Santa Monica, California, and the rest of the word.
Our address: SAG-AFTRA Plaza, 5757 Wilshire Blvd., Suite #5, Los Angeles, CA 90036
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