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).

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.

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.

Ultrasound imaging.

Drug injections or infusion for diagnostic purposes.

Psychological evaluation.

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.

Self-management and exercises.

Thermal therapy.

Physical therapy.

Relaxation therapy.

Occlusal splint.

Counseling.

Anti-inflammatory drugs (steroidal and NSAIDS).

Message therapy.

Spa therapy.

Trigger point injections.

Botox injection.

Steroid or Hyaluronic acid joint injection.

Arthrocentesis of the joint.

Acupuncture and dry needling.

Electrical stimulation.

Ultrasound.

Pain modulating drugs such as TCA anti-depressants.

Cognitive-behavioral training.

Medications including the triptans, antidepressants, anticonvulsants, muscle relaxants and the recently FDA approved medications including some DMARDS and CGRP antagonists.

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.

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.

Sleep disorders such as snoring and obstructive sleep apnea.

Preventive dentistry.