Orofacial Pain

Contents

Erratum ix

Preface xi
Scott S. De Rossi and David A. Sirois

Orofacial Pain: A Primer 383

Scott S. De Rossi
Orofacial pain refers to pain associated with the soft and hard tissues of
the head, face, and neck. It is a common experience in the population
that has profound sociologic effects and impact on quality of life. New
scientific evidence is constantly providing insight into the cause and
pathophysiology of orofacial pain including temporomandibular disor-
ders, cranial neuralgias, persistent idiopathic facial pains, headache,
and dental pain. An evidence-based approach to the management of
orofacial pain is imperative for the general clinician. This article reviews
the basics of pain epidemiology and neurophysiology and sets the stage
for in-depth discussions of various painful conditions of the head and
neck.

Clinical Assessment of Patients with Orofacial Pain and Temporomandibular

Disorders 393
Ilanit Stern and Martin S. Greenberg
Accurate diagnosis of chronic pain disorders of the mouth, jaws, and face
is frequently complex. It is common for patients with chronic orofacial pain
to consult multiple clinicians and receive ineffective treatment before a cor-
rect diagnosis is reached. This problem is a significant public health con-
cern. Clinicians can minimize error by starting the diagnostic procedure
with a careful, accurate history and thorough head and neck examination
followed by a thoughtfully constructed differential diagnosis. The possibil-
ity that the patient has symptoms of a life-threatening underlying disease
rather than a more common dental, sinus, or temporomandibular disorder
must always be considered.

Diagnostic Imaging for Temporomandibular Disorders and Orofacial Pain 405

Allison Hunter and Sajitha Kalathingal
The focus of this article is diagnostic imaging used for the evaluation of
temporomandibular disorders and orofacial pain patients. Imaging modal-
ities discussed include conventional panoramic radiography, panoramic
temporomandibular joint imaging mode, cone beam computed tomogra-
phy, and magnetic resonance imaging. The imaging findings associated
with common diseases of the temporomandibular joint are presented
and indications for brain imaging are discussed. Advantages and
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disadvantages of each imaging modality are presented as well as illustra-

tions of the various imaging techniques.

Differential Diagnosis of Orofacial Pain and Temporomandibular Disorder 419

Anil Kumar and Michael T. Brennan
When a patient complains of orofacial pain, health care providers must make
a correct diagnosis. Doing this can be difficult, since various signs and symp-
toms may not be specific for 1 particular problem or disorder. One initially
should formulate a broad differential diagnosis that can be narrowed after
analysis of the history and examination. In this article, orofacial pain is cate-
gorized as being caused by: intracranial pain, headaches, neuropathic pain,
intraoral pain, temporomandibular disorder, cervical pain, pain related to
anatomically associated structures, referred pain, or mental illness.

Intraoral Pain Disorders 429

Joel J. Napeas
Dental and oral diseases are common findings in the general population.
Pain associated with dental or periodontal disease is the primary reason
why most patients seek treatment from providers. Thus, it is essential
that all complaints of pain in the mouth and face include ruling out pain
of dental origin. However, intraoral pain is not exclusively a result of dental
disorders. This review outlines common somatic intraoral pain disorders,
which can originate from disease involving one or more broad anatomic
areas: the teeth, the surrounding soft tissues (mucogingival, tongue, and
salivary glands), and bone.

Disorders of the Masticatory Muscles 449

Scott S. De Rossi, Ilanit Stern, and Thomas P. Sollecito
Muscle disorders involving the masticatory muscles have been considered
analogous to skeletal muscle disorders throughout the body. However,
emerging research has shed new light on the varied etiology, clinical pre-
sentation, diagnosis, and treatment of myofascial pain and masticatory
muscle disorders. This article reviews the etiology and classification of
regional masticatory muscle disorders, the clinical examination of the
patient, and evidence-based treatment recommendations.

Epidemiology, Diagnosis, and Treatment of Temporomandibular Disorders 465

Frederick Liu and Andrew Steinkeler
Temporomandibular disorder (TMD) is a multifactorial disease process
caused by muscle hyperfunction or parafunction, traumatic injuries, hor-
monal influences, and articular changes. Symptoms of TMD include
decreased mandibular range of motion, muscle and joint pain, joint crepi-
tus, and functional limitation or deviation of jaw opening. Only after failure
of noninvasive options should more invasive and nonreversible treatments
be initiated. Treatment can be divided into noninvasive, minimally invasive,
and invasive options. Temporomandibular joint replacement is reserved for
severely damaged joints with end-stage disease that has failed all other
more conservative treatment modalities.
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Cranial Neuralgias 481

Wendy S. Hupp and F. John Firriolo
This article describes the clinical findings of cranial neuralgias, such as tri-
geminal neuralgia, glossopharyngeal neuralgia, nervus intermedius neural-
gia, and others, and postherpetic neuralgia. Pathophysiology of these
neuralgias, diagnostic methods, and treatment are also discussed. This
information will enable the dentist to diagnose patients who have these
rare conditions.

Burning Mouth Syndrome 497

Jaisri R. Thoppay, Scott S. De Rossi, and Katharine N. Ciarrocca
Burning mouth syndrome (BMS) is a chronic condition that is character-
ized by burning symptoms of the oral mucosa without obvious clinical
examination findings. This syndrome has complex characteristics, but its
cause remains largely enigmatic, making treatment and management of
patients with BMS difficult. Despite not being accompanied by evident
organic changes, BMS can significantly reduce the quality of life for
such patients. Therefore, it is incumbent on dental professionals to diag-
nose and manage patients with BMS as a part of comprehensive care.

Primary Headache Disorders 513

Rafael Benoliel and Eli Eliav
Primary headache disorders include migraine, tension-type headaches,
and the trigeminal autonomic cephalgias (TACs). Primary refers to
a lack of clear underlying causative pathology, trauma, or systemic dis-
ease. The TACs include cluster headache, paroxysmal hemicrania, and
short-lasting neuralgiform headache attacks with conjunctival injection
and tearing; hemicrania continua, although classified separately by the
International Headache Society, shares many features of both migraine
and the TACs. This article describes the features and treatment of these
disorders.

Topical Medications as Treatment of Neuropathic Orofacial Pain 541

Cibele Nasri-Heir, Junad Khan, and Gary M. Heir
Understanding mechanisms of neuropathic orofacial pain, targets of treat-
ment, and basic pharmacology and working with informed compounding
pharmacists may result in significant benefit for patients. The clinical sig-
nificance of topical medications is improvement of quality of life for pa-
tients by providing a unique medication delivery system for neuropathic
orofacial pain and other dental and extraoral conditions. The use of this
route of administration has decreased or minimized side effects compared
with other methods and is especially useful in medically compromised and
elderly patients. These innovations, supported and improved by ongoing
research, will augment the armamentarium of the clinician treating orofa-
cial pain disorders.

Index 555