Your Los Angles Orofacial Pain & TMJ Specialist
Given that many people in the United States struggle with orofacial pain, it is now officially recognized as a pain specialty.
Museum Dental Center in Beverly Hills, Los Angeles, CA is a recognized specialist in the area of orofacial pain. Dr. Mohammad Khalifeh is dedicated to providing the best dental services for dental patients suffering with on-going pain that impacts their ability to chew, smile, enjoy an accurate bite and be pain free.
Orofacial Pain was recognized as the 12th American Dental Association (ADA) dental specialty by the aaop.org. Currently, 329 active Orofacial pain board certified members across the globe came to agreement on this; 232 of them practice in the United States.
What is Orofacial Pain?
Orofacial Pain (OFP) is a medical specialty that requires dentistry training. This new specialty deals with local and systemic disorders that cause pain and/or dysfunction in the mouth, face, head, and neck regions. It covers the diagnosis, management, and treatment of painful disorders of the jaw, mouth, face and the associated areas of the body that they impact.
According to the American Academy of Orofacial Pain (AAOP): “The specialty of OFP is dedicated to the evidenced-based understanding of the underlying pathophysiology, etiology, prevention, and treatment of these disorders and improving access to interdisciplinary patient care. These disorders as they relate to Orofacial pain include but are not limited to: temporomandibular muscle and joint (TMJ) disorders, jaw movement disorders, neuropathic and neurovascular pain disorders, headache, and sleep disorders.”
Orofacial pain 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 mutable sclerosis.
7. Vascular problems such as stroke.
8. Hereditary conditions like migraine headaches.
9. Infections 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 highly prevalent and debilitating conditions. The pain may be felt in your teeth and face despite being caused by from other areas of the head. A 2002 systematic review studying the prevalence of 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 Typical Symptoms of Orofacial Pain?
The symptoms of Orofacial pain includes headaches, neck pain, ear pain, dental pain, facial burning or stabbing sensations, and jaw joint (TMJ) pain.
In list format, the common symptoms of Orofacial Pain are:
- Jaw pain.
- Facial pain.
- Neck pain.
- Tooth pain.
- Clicking, popping, or locking in the Temporomandibular joints (TMJ).
- Ear pain, ringing in the ears, or plugged ears.
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. Persistent pain or disease in this area can deeply affect an individual; it occurs 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.
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 successful care. These well-trained specialists are recognized by both Medicine and Dentistry (3).
How is Orofacial Pain Disease Diagnosed?
Diagnosis of orofacial pain can be difficult, as it may require multiple examinations and medical histories provided by the patient. 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. 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 that has questions about their chief complaint, history of present illness, systemic health conditions, medications and allergies, hospitalization, surgeries, family history, social history and psychological history.
A thorough 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, and any abnormality or deviation will be reported. 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.
- Ultrasound imaging.
- Drug injections or infusion for diagnostic purposes.
- Psychological evaluation.
What Common Treatments are used to Relieve Orofacial Pain?
Managing Orofacial pain conditions is dictated by the type of problem each patient is experiencing. There is no one treatment that fits all conditions. One or more of the following treatment modalities might be used to help reduce the suffering of patients with this condition.
Treatment and remedies for Orofacial Pain conditions may include:
- Self-management and exercises.
- Thermal therapy.
- Physical therapy.
- Relaxation therapy.
- Occlusal splint.
- 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.
- 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.
What is the Long-term Outcome of Orofacial Pain Treatment?
Clinical trials and systematic reviews have shown that the long-term outcomes of patient-centered rehabilitation approaches such as splints, exercise, physical therapy, cognitive-behavioral training, mindfulness, and relaxation may prevent long-term chronic pain, addiction, and disability in nearly every patient.
Orofacial pain specialists provide evidence-based treatments to improve Orofacial pain conditions. It may 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, a pain coach to support self-care changes, a pain psychologist to provide counseling for depression and other psychosocial factors that complicate pain. 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.
Dr. Khalifeh, DDS can take of you!
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.
- Bruxism and related problems.
- Other oro-facial motor disorders such as dystopia and dyskinesia.
- Sleep disorders such as snoring and sleep apnea.
- Preventive dentistry.
Case Studies Treating Dental Patients in the Orofacial Region
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 was described as moderate to sever in intensity that is always present. Sometimes it presents as a sharp, shooting pain that is stimulated by biting on her teeth or chewing food. Over the counter pain medications including Advil and Tylenol were not helping.
Clinical 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. The patient was prescribed antibiotics for 5 days and was asked to come back after a week if she continued to feel pain.
After one week, the patient returned but her pain didn’t improve. The gum infection was no longer present. Ice test for the teeth was equivocal. The front teeth were numbed using local anesthetic infections, and the patient continued to feel the pain in the same tooth although the side of her face was very numb.
As an Orofacial pain specialist, I understand that tooth ache is not always a true tooth problem although the pain is presented as a tooth ache. Unfortunately, the patient’s health insurance doesn’t cover her treatment in my office because I am not in network in the patient’s health plan. To help the patient, I explained to her that her pain is mostly not a real tooth problem although it is presented as a toothache.
I gave her a referral to a neurologist in her network and relayed my initial diagnosis that this patient has a neuropathic (nerve disease) type of pain related to her fifth cranial nerve. I suggested that she get a brain MRI to exclude brain tumor or vascular compression of the trigeminal nerve root ganglia. I also suggested to place the patient on anticonvulsant medication to help reduce the pain intensity.
MRI was taken and was negative. No tumor and no vascular nerve compression were noticed. Patient was prescribed Carbamazepine (a drug used to manage epilepsy) 100 mg 3 times / day. Her pain was gone in few days after she took the medication. After 2 weeks of taking the Carbamazepine, the patient stopped taking it for 2 days, resulting in the pain returning. She started taking the medication again, and her pain went away.
The diagnosis for this case was Atypical Trigeminal Neuralgia, a condition that is very 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. They usually get several root canal treatments, endodontic surgeries, dental extractions, 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 last molar that is disturbing his life and interfering with his sleep. He requested 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, and the tooth was healthy.
A trigger point injection to the right masseter muscle using local anesthesia gave the patient instant and lasting pain relief without a root canal or any dental treatment.
One research study revealed that 17% of what felt as tooth pain are actually referred pain from masticatory muscles. The patient was very happy with his treatment outcome, and he continues to talk about this story every time he shows up for hygiene appointment.
Pain of Dysfunction in the Orofacial Region
Dr. Khalifeh is not only an active diplomate American Board of Orofacial Pain but also runs the Orofacial Pain Board preparation course at the USC Orofacial Pain specialty program. He helped more than 20 specialist dentists earn their diplomate status in Orofacial Pain.
He is involved in several research projects on the subject of Orofacial Pain. He is a an (shouldn’t have both “a” and “an”) expert on using Botox for managing musculoskeletal pain in the head and neck region. In 1996, he published a systematic review and meta-analysis on the subject of Botox for management of myofascial pain in the head, neck and shoulder regions, the first and largest study on this subject.
Download our easy to read PDF on Orofacial Pain and TMJ Disorders.
If you or anyone you know is suffering from pain of dysfunction in the Orofacial region, do not hesitate to contact Dr. Khalifeh.
Phone: (323) 933-3855
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. https://www.sciencedirect.com/science/article/abs/pii/S1532338202700729?via%3Dihub
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