How Orofacial Pain Is Diagnosed by Endodontists

Woman holding face in pain

Orofacial pain isn’t a disease, but a specific collection of diseases exhibiting similar symptoms. The underlying causes of orofacial pain can be complex because even if the pain can be determined as odontogenic or nonodontogenic, the regions affected have to be further diagnosed by its pathologies, anatomical regions, and other external factors that relate to those symptoms. An example of such complexity is TMJ disorder, a musculoskeletal disorder that causes orofacial pain along with the lower and upper areas of the temporomandibular joint. Orofacial pain, however, is normally sourced from dental causes, such as a dental abscess or pulpitis, and other sources, including the head and neck region, tend to be rarer. 

But beyond dental causes, orofacial pain can also have neurovascular, neuropathic, or musculoskeletal causes. Some of the most common sources of orofacial pain include: 

  • Burning Mouth Syndrome: Burning mouth syndrome often results from some form of nerve damage surrounding the facial muscles, but can also be sourced from fungal infections, decreased saliva production, medications, and other systemic diseases like diabetes. 
  • Sleep Disorders: Bruxism and mouth clenching can often cause orofacial pain, as well as sleep conditions such as sleep apnea or snoring. 
  • Neurovascular Disorders: Migraines can also cause orofacial pain due to the intensity of moving lights, nausea, and auras. Cluster headaches and tension headaches can also lead to orofacial pain. 
  • Neuropathic Pain Disorders: Trigeminal neuralgia, a condition that causes pain along the nerves, causes spontaneous electric shock-like pains that limits the nerve, and if located in the facial area, can cause orofacial pain. Continuous neuralgias cause constant burning and aching with episodes of shooting pain. Due to the nature of these conditions, it can be difficult to treat. 
  • Temporomandibular Disorders: Unlike TMJ, temporomandibular disorders encompass a broader categories of pain and dysfunction of the jaw joints. 
  • Trauma: Any patients that recently experienced accidents, such as an automobile accident, often causes temporomandibular disorders and orofacial pain. 
  • Neck and Spine Injuries: Neck pain, also called cervicalgia, can influence orofacial pain due to spinal injuries, and can also influence the nerves, muscles, and ligaments. 
  • Dyskinesia and Dystonia: Involuntary and erratic movements along the face, arms, and legs can cause orofacial pain due to the intensity and frequency of muscle spasms. 

How Endodontists Determine Orofacial Pain

Endodontic conditions are often accompanied by orofacial pain, but to truly help diagnose and manage these conditions, it takes a multi-disciplinary approach through the cooperation of multiple specialties to truly tackle orofacial pain. However, endodontists have to have specific protocols to be able to properly diagnose conditions. More often, the main focus on diagnosis is to determine whether the pain is sourced from the endometrium area, rather than pain sourced from the jawline, spine, or other sources of pathology. 

Orofacial pain can also be further diagnosed by the type of pain experienced, and then narrowed down to the conditions potentially affecting the patient: 

  • Odontogenic Pain: Odontogenic refers to pain that originates from dental structures, such as the teeth, periodontal region, and pulpal areas of the teeth. Conditions such as acute nercotic gingivitis and infected pulpitis can cause these types of pain. 
  • Nonodontogenic Pain: Nonodontogenic refers to the intraoral structures such as the gingiva (gums) and buccal mucosa (cheek lining). This includes mouth ulcers, burning mouth syndrome, and oral mucositis.  
  • Heterotopic Pain: Considered the most common type of pain, heterotopic pain is a type of pain perceieved in a region different from the original source of pain, making it difficult for clinical evaluations that only rely on reported symptoms. 
  • Nociceptive Pain: Nociceptive pain, also called somatic pain, bring a localized sense of discomfort or distress from specific nerve endings, causing reactions. The source of pain can come from outside the nervous system, and typically exhibit peripheral sensation when interacted with in any way. 
  • Non-nociceptive Pain: Also called neuropathic pain, this type of pain often is created by a circulatory malfunction, setting off false alarms throughout the nervous system and creates sensitivities that cause symptoms of pain in certain areas. Orofacial pain can be caused by this type of pain when conditions like migraines and neuralgias are present. 

For endodontists, it takes various techniques to be able to address the numerous orofacial conditions that affect patients daily. However, the main technique to truly addressing patients’ pain is to observe their medical history and treat any presiding symptoms as coming from endodontic origin unless presented otherwise. Because our areas of specialty work within the endometrium and periodontal areas of the mouth, conditions resulting from nerve pain throughout the tooth, gingivitis, and tooth decay caused by severe infections in the root canals have to be sourced out through analysis and treatments. 

In these cases, x-rays, CT scans, medical history observations, and family history observations can help endodontists expand further through the diagnosis process. Once a condition has been determined, endodontic protocols and treatments will then be further discussed with the patients. In other cases where the source of the orofacial pain doesn’t reside within the endometrium area, then referrals to specialists, including ENTs, sleep physicians, chiropractors, and orthodontists, can be recommended for more specialized treatment. 

Managing Patients With Long-Term Orofacial Pain 

Because of the high rate of misdiagnosis with chronic orofacial pain, proper diagnosis is an essential part of effective endodontic treatment. In cases where sources of pain result from areas outside the endometrium, specific cases can be used to help work with long-term management techniques, including exercises, prosthetic devices, medications, and other forms of multimodal therapy that can be used to treat orofacial pain. Ultimately, the decision to help manage endodontic orofacial pain needs to be discussed between the endodontists and the affected patient to help them find more effective solutions. Chronic orofacial pain can present some highly challenging scenarios, but when established protocols and treatments are made in any endodontic practice, these sources of pain can be treated through the right methods. 

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