Oral medicine 9: orofacial pain

Specialist referral may be indicated if the Practitioner feels:

Pain in the teeth, mouth, face or head usually has a local cause – often the sequelae of dental caries (odontogenic pain) – but psychogenic, neurological, vascular and conditions where pain is referred from elsewhere may be responsible (Table 1).

Dental staff will be well versed in pain of local cause and therefore this article discusses mainly the conditions in which specialist help may be indicated. Many of the conditions discussed in previous articles in this series may cause pain.

The real significance to the patient of orofacial pain, apart from the pain itself, can range from the benign to potentially lethal conditions. Some orofacial pain or headaches have an obvious but relatively unimportant cause (eg a hangover – caused mainly by the acetaldehyde resulting from metabolism of alcohol); other types of pain have no obvious underlying organic pathology (and are thus termed medically unexplained symptoms (MUS), eg atypical facial pain); some can threaten important faculties such as sight (eg giant cell arteritis), or even life (eg brain tumours).