What is Orofacial Pain?


An Overview of Orofacial Pain

The term “orofacial pain” represents various elements of pain that occur in the region of the mouth, head, face and neck.  While dentists in general are experts in dealing with problems found within the mouth and teeth, there is currently no requirement that dental schools provide any standardized education regarding pain emanating from the joints, muscles, tendons, ligaments and nerves associated with the functions of the jaws.  Fortunately, there are at least a dozen post-graduate programs nation-wide that provide advanced education and clinical training in the diagnosis and management of these conditions.

The jaws, of course, are essential for survival in that they provide critical functions such as chewing, talking, breathing and swallowing as well as additional activities such as yawning, yelling, singing, etc.  To perform these functions, the jaws must be capable of movement just like other functioning body parts like arms and legs.  However, if a person develops a problem with the knee or elbow, there is little doubt about the origin of the pain associated with that condition.  On the other hand, orofacial pain conditions can result in a broad variety of pain complaints that can include the head, neck, ears, eyes, nose, throat, sinuses and jaws.  Thus, the actual source of the pain may not be the actual site where the person experiences the pain.  This is also known as “referred pain”.

Orofacial pain complaints can encompass a broad variety of headaches and nerve related pains as well.  The primary nerve pathways associated with pain from all of these regions of the head, face and neck involve what is known as the trigeminal nerve and its associated pathways to the brain.  Thus, a patient may experience confusion as to the source of a pain experience.  A common example is ear pain associated with pain emanating from the jaw joint or the TMJ (temporomandibular joint).

Sleep related breathing disorders such as snoring and obstructive sleep apnea are also associated with the functions of the jaw, tongue, tonsils and soft palate.  As such, disturbed sleep is a substantial aggravating and perpetuating factor in orofacial pain.  In addition, tooth clenching and grinding, as well as other oral habits, are often a response to various stressors such as being cold (Vermont weather), physical exertion and a broad variety of emotional circumstances.  Again, another contributing factor to orofacial pain.

Complicating the above is the fact that while dentists are trained in the evaluation, diagnosis and management of these conditions, treatment typically follows the medical model of care.  Thus, there is often confusion about the health insurance coverage for these conditions.  Dental insurance views these conditions as medical and medical insurance will often declare these problems as dental or even “bogus”.  It is truly astonishing that insurers can exclude coverage for care for that portion of the body that serves as a pathway for communication, nutrition and breathing!

Vermont Orofacial Pain Associates strives to provide access to care for patients who suffer from these conditions.  This includes a thorough history, examination, cone-beam CT scanning, accurate diagnosis and various forms of treatment.  We also focus much of our attention on patient education regarding all the variable factors that contribute to and influence the experience of orofacial pain.  

And one final note:  TMJ is not a diagnosis; it is simply the name of a joint.  How would you react if your health care provider told you that you have “knee” or “elbow”?