Facial Pain

Most orofacial pain conditions cause pain or tenderness specifically in the mouth or face. The pain can range from mild to so severe that it interferes with tasks of daily living. 

There are several types of orofacial pain, including myofascial and neuropathic pains. Relief can be found through correct diagnosis and treatment that reduces pain symptoms.

Neuropathic Pain Disorders

Neuropathic pain disorders result from disorder or injury to the nervous system. Descriptions of the neuropathies that most commonly affect the head and facial regions follow.

Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a facial pain condition that affects the trigeminal nerve and causes severe pain on one or both sides of the face. The onset of TN is often sudden and triggered by minor, everyday activities.

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Atypical Odontalgia

Also known as “phantom tooth” pain, AO is a persistent pain in a tooth or site of dental treatment without evidence of a dental condition that would account for the pain.

Atypical Odontalgia

AO is a type of chronic pain that often affects the area where a tooth has been extracted, including adjacent teeth, gums, or mouth and face. Its symptoms are often misdiagnosed because they don’t follow the typical pattern of tooth pain. Symptoms

  • Continuous or intermittent dull or throbbing ache or pain that resembles a toothache, varying in intensity from mild to severe
  • May radiate to surrounding areas, including the jaw, gums, or other teeth
  • Extended periods of pain may occur, even without stimulation
  • Altered sensation in the affected area, including numbness or hypersensitivity
  • Certain triggers like stress, chewing, or temperature changes might exacerbate the pain
  • Lack of clinical signs of problem in the affected area, and typical diagnostic tests may not reveal any underlying dental issues
  • Unresponsive to typical dental treatments such as fillings, root canals, or even extractions

The ongoing, chronic nature of AO pain can lead to emotional distress and anxiety, further complicating treatment. Causes The cause of AO is unknown, however, some experts believe that it may be a result of  interruption or elimination of nerve fibers (deafferentation). Several factors are thought to contribute to this condition:

  • Dental procedures, like root canals or extractions
  • Migraine and cluster headaches
  • Psychological factors, such as stress and anxiety

Complex Regional Pain Syndrome

CRPS can affect the craniofacial region, though is more common in the arms and legs. The pain is described as a continuous burning sensation that may be accompanied by changes in skin temperature, color, and texture, increased skin sensitivity, and swelling and stiffness.

Complex Regional Pain Syndrome (CRPS)

CRPS, also known as causalgia or reflex sympathetic dystrophy syndrome, is a rare chronic pain condition in which continuous aching pain manifests in a localized area. It can lead to emotional issues such as anxiety, depression, and mood changes. Additionally, prolonged CRPS might lead to a decrease in bone density in the affected area. CRPS affects men and women of all ages.

Symptoms

  • Continuous burning or throbbing pain
  • Swelling and stiffness
  • Changes in skin temperature, color, and texture
  • Muscle atrophy and weakness
  • Increased skin sensitivity
  • Coordination and movement issues

Causes

CRPS is thought to originate by trauma to tissue or nerves, which triggers the sympathetic nervous system to maintain active pain pathways. It’s not the severity of the injury, but rather the body’s response to it, that causes the syndrome.

  • Injury or surgery
  • Abnormal inflammatory response
  • Nervous system malfunction
  • Genetic factors
  • Psychological factors
  • Immune response

Secondary factors, such as immobilizing an affected limb after an injury, might exacerbate CRPS.

Oral Nerve Injury

This chronic pain condition occurs when nerves in the jaw are damaged, usually resulting from a dental procedure or injury. The result is pain and burning sensation, numbness or tingling of the tongue, mouth, or lower lip.

Oral Nerve Injury

Oral nerve injury affects any nerve supporting the jaw and/or teeth. It can cause pain, tingling, or numbness in the tongue, mouth, and lower lip. Symptoms can be significant, and if they become chronic, can potentially lead to emotional distress, anxiety, or depression.

Symptoms

  • Sharp, shooting, or burning pain
  • Aching or throbbing sensation
  • Pain triggered by touch or temperature changes
  • Numbness or a tingling sensation in the lips, tongue, gums, or cheeks
  • Tingling or “pins and needles” sensation
  • Hypersensitivity to touch, temperature, or pressure
  • Change or loss of taste
  • Difficulty in speaking or articulating words
  • Difficulty swallowing or controlling saliva
  • Weakness or paralysis of muscles in the affected area

Causes

  • Dental procedures, such as tooth extractions, implant surgery, root canal therapy, or local anesthetic injections
  • Trauma, such as jaw fractures, lacerations, or burns
  • Tumors or cysts
  • Infections
  • Orthognathic surgery
  • Radiation for cancers in the head and neck region
  • Autoimmune diseases, such as multiple sclerosis

Burning Mouth Syndrome (BMS)

BMS is a painful sensation in the mouth or tongue, sometimes accompanied by dry mouth or taste changes.

Burning Mouth Syndrome (BMS)

BMS is characterized by a chronic or recurrent burning sensation in the mouth without any apparent cause. The pain can be continuous or intermittent and may affect the tongue, lips, gums, palate, throat, or the whole mouth.

Symptoms

  • Burning or scalded sensation
  • Dry mouth
  • Altered or loss of taste
  • Worsened pain throughout the day
  • Thirst
  • Difficulty eating or sleeping

Causes

The exact cause of BMS might not always be easily identified. Factors and underlying conditions that may contribute to the condition include:

  • Hormonal changes (e.g., menopause)
  • Nutritional deficiencies
  • Dry mouth
  • Oral conditions
  • Medications
  • Allergic reactions
  • Nerve damage
  • Gastroesophageal reflux disease (GERD)
  • Stress, anxiety, or depression
  • Chronic conditions such as diabetes and thyroid disorders
  • Dental procedures or poor-fitting dentures
  • Alcohol and tobacco use

In some cases, no identifiable cause can be found, and the BMS condition is termed “idiopathic.”

Atypical Face Pain

The diagnosis of atypical face pain is a diagnosis of exclusion, meaning that the patient experiences unexplained, ongoing pain in the face that can’t be attributed to any other diagnosis. Symptoms are similar to those of trigeminal neuralgia and the two conditions can be hard to tell apart, given that the root cause of atypical face pain is often a form of neuropathy of the trigeminal nerve.

Atypical Face Pain

There remains considerable uncertainty as to what may increase the incidence of orofacial neuropathy. Sometimes the condition defies categorization. Yet atypical facial pain — severe, chronic pain that does not fit a clear diagnosis — can still be treated to bring patients relief.

Myofascial Pain Conditions

Myofascial pain is characterized by trigger points in the musculature of the face and jaw. When a trigger point is activated, the muscle fibers contract and create a taut band of muscle tissue. The resulting sensation is soreness, aching, or burning muscle pain, which may take the form of referred pain (pain in an area other than the point of origin).

Potential causes of active muscle trigger points include:

  • Repetitive overuse injury
  • Habitual poor posture
  • Direct injury
  • Sustained heavy lifting
  • Regular muscle tension and clenching
  • Prolonged inactivity

Patients with chronic myofascial pain, including TMJ disorders, typically require several treatments to alleviate the pain symptoms associated with the condition. A comprehensive treatment plan may include physical therapy, therapeutic injections, and medication management.

Diagnosis

The cause (or causes) of orofacial pain can be difficult to identify because many of the symptoms of different conditions overlap. Diagnosis requires a thorough and multidisciplinary approach. 

As with any diagnostic process, a provider will take a full medical history and description of symptoms, perform a physical exam, and order any necessary tests or scans. Based on their findings, and their knowledge of the full spectrum of orofacial pain syndromes, an expert provider can develop an understanding of the unique problem of each individual patient.

Sometimes the cause of neuropathic pain cannot be precisely identified. In this case, a process of applying varying treatments usually offers the best way to bring relief. It’s important for patients to choose providers who offer a wide variety of treatment options.

Treatment

Treating facial pain requires a comprehensive, individualized approach that may include various methods depending on the cause, severity, and type of dysfunction. Treatment should be guided by healthcare providers who specialize in Orofacial Pain, as they are trained to diagnose and manage these complex conditions. 

Therapies we offer include medication management, oral appliances, and therapeutic injections.

Our Approach

We are experts with deep experience with the many forms and causes of orofacial pain. We work as a team — with each other and with you and your referring providers — to understand your condition and find an appropriate diagnosis. We offer a large array of therapies and are committed to finding a solution that brings you relief.