face

Orofacial Pain

Causes for Orofacial pain which have to be ruled out;

Orofacial pain is the Pain felt in the face and mouth

    • Tooth Decay: Cavities can cause pain in the affected tooth and surrounding areas.
    • Gum Disease (Periodontitis): Inflammation and infection of the gums can cause pain.
    • Tooth Sensitivity: Can occur due to enamel erosion or gum recession.
    • Tooth Abscess: An infection at the root of a tooth can cause severe pain.
    • Bruxism: Grinding or clenching teeth can lead to muscle pain and discomfort.
  1. TMJ Dysfunction: Pain and dysfunction in the temporomandibular joint, which connects the jawbone to the skull.
  2. Jaw Alignment Issues: Problems with the alignment of the jaw can cause pain.
  1. Sinus Infections: Inflammation of the sinuses can cause facial pain, especially around the eyes, cheeks, and forehead.
  1. Migraines: Often involve pain in the face or around the eyes.
  2. Cluster Headaches: Intense pain typically focused around one eye.
  3. Tension Headaches: Can cause general facial and head discomfort.
  1. Trigeminal Neuralgia: A chronic pain condition affecting the trigeminal nerve, which can cause sharp, shooting pain in the face.
  2. Postherpetic Neuralgia: Pain following an outbreak of shingles that affects the facial nerves

Other causes: Fibromyalgia, Psychological factors such as stress and anxiety.

TMJ Pain

Temporomandibular Disorders include both Masticatory Muscle Disorders and Temporomandibular Joint Disorders
TMJ Pain

Masticatory Muscle Disorders

  • Myofascial Pain (pain with localized tenderness)
  • Myositis (pain with generalized tenderness)
  • Contracture (chronic limited opening)
  • Muscle Spasm (acute limited opening)

Temporomandibular Joint Disorders

  • Arthralgia (pain and tenderness)
  • Disc Disorder (clicking and locking)
  • Arthritis (pain with degeneration)
  • Arthrosis (degeneration)

Normal Temporomandibular Joint

  • Articular Eminence
  • Intra-articular Disk
  • Mandibular Condyle
  • Posterior Attachment
  • Superior Lateral Pterygoid Muscle
  • Inferior Lateral Pterygoid Muscle
  • Internal Auditory Meatus
Normal Temporomandibular Joint

TMJ Disk Disorder- with reduction (I, II)

  • Reciprocal clicking that is reduced with anterior positioning of jaw
  • Stage II includes intermittent locking
  • Range of motion is normal
  • With or without pain or tenderness (arthralgia)
TMJ Disk Disorder- with reduction (I, II)

TMJ Disk Displacement- without reduction (III, IV)

  • Locked with limited opening due to disk interference
  • Stage IV disk pushed forward and opens over time
  • Mouth opening deviation to side of lock
  • With or without pain or joint tenderness (arthralgia)
TMJ Disk Displacement- without reduction (III, IV)

TMJ Disk Degenerative Joint Disease (V)

• Coarse crepitus or grating noises on opening
• Range of motion can be normal
• With or without pain and arthralgia

TMJ Disk Degenerative Joint Disease (V)

Myofascial Pain

A repetitive strain injury of the muscles associated with regional pain and localized
tender spots in muscle, tendon, or fascia that reproduces pain.

Muscle involved in TMJ pain: Deep Masseter, Anterior Temporalis, Splenius Capitis

Most common Risk factors for developing Chronic jaw pain

  1. Opening too wide or for too long during dental visits and tooth extraction.
  2. Motor vehicle accidents including whiplash injuries, direct blows to the jaw, and clenching of the jaw before, during and after the impact.
  3. Sports injury

Treatments that are used for Temporomandibular disorders and number of clinical trials showing some efficacy.

  1. Splints and occlusal treatments
  2. Stabilization (hard and soft), repositioning and anterior splints, occlusal adjustment, restorative dentistry, and functional orthodontic splints
  3. Physical medicine and exercise
  4. PT modalities, exercise including stretching, posture, conditioning
  5. Therapeutic Injections and acupuncture
  6. Trigger point injections, Botox injections, TMJ joint injections, acupuncture
  7. Psychological therapies; Cognitive-behavioral treatment, Biofeedback, Relaxation
  8. Pharmacologic therapy (Oral medications)