Facial Pain

Patients who experience persistent pain in the head and neck should be evaluated by an orofacial pain specialist. Unfortunately, some patients who don’t seek out this type of specialist undergo unnecessary tests and even treatments, such as gum surgery or tooth extractions, before finding out that their “toothache” isn’t coming from the tooth at all.

An orofacial pain specialist will perform a comprehensive examination consisting of:

A thorough evaluation of the patient’s history
The recording of exact symptoms
Evaluation of all previous medications and treatments
Testing the affected areas with touch, and hot or cold sensations
Simple neurological tests

In some cases, blood or urine tests, along with imaging diagnostic tests such as MRI, CT scans or X-rays may be ordered. A series of diagnostic injections, similar to what is performed during a tooth filling, may be used to discover if the pain is peripheral, central or both. Psychological tests may also be appropriate, since anxiety and depression often accompany persistent pain.

Gathering all of this information will help the physician make an accurate diagnosis, and plan an effective treatment strategy. Treatments are sometimes performed on a trial basis, and several treatments may be attempted before the best option is discovered. The physician may also use a multidisciplinary approach, enlisting the help of several other professionals.

Pre-Trigeminal Neuralgia

Some patients experience a deep, dull and achy pain in the face or teeth. This pain may be constant, or come on spontaneously. This pain eventually develops into trigeminal neuralgia (TN), and is treated with the same medications. Pre-trigeminal neuralgia can be difficult to diagnose, because the symptoms are very similar to TN.

Atypical Odontalgia (Phantom Tooth Pain)

Sometimes, pain starts at the peripheral nerves that go to the teeth, and at times progresses into the central part of the nervous system that senses tooth pain. For those whose pain comes from the nerves close to the teeth and gums, injections of local anesthetics and steroids may be effective. In those patients where the pain is central, medications such as antidepressants, anti-seizure medications and sometimes narcotics may be used to alleviate symptoms.

With “phantom tooth pain,” nothing is physically wrong with a patient’s teeth. Unfortunately, many patients who suffer from this kind of pain undergo unnecessary dental procedures in an attempt to alleviate the pain. This is why a thorough diagnosis from an orofacial pain specialist is crucial, if dental examinations cannot explain the pain.

Complex Regional Pain Syndrome

Where atypical odontia involves changes in the peripheral and central parts of the nervous system, complex regional pain syndrome (CRPS) involves the sympathetic nervous system. This is the part of the nervous system that controls blood flow, so patients often complain of a cold feeling in addition to pain, because of the narrowing of blood vessels in that area. CRPS is most often present in the legs and arms, but can also occur in the face.

Treatment for CRPS typically involves antidepressants, blood pressure control, and pain medications. Physical therapy can also help, as can injections into certain areas of the main nerve intersections. A surgical procedure called a sympathectomy that treats specific nerves in the surrounding area is also an option. This is usually performed only if other treatment plans have failed.