Orofacial pain in the dental clinic

Abstract

Most dental consultations are related to intraoral pain disorders affecting dental, periodontal and mucosal structures. Although the originating cause of pain and the anatomical structure frequently co-localise, orofacial pain and particularly oral pain are sometimes referred. That is, pain may be caused by extraoral processes out of the maxillofacial territory. Likely, some intraoral conditions such as an occlusal imbalance may also affect extraoral structures, leading to tension and pain on the neck, head, and back. Orofacial pain research is however an emerging discipline in comparison to other anatomical regions. This may be due, in part, to the fact that oral pain tends to recede over time or after tissue healing –in case there was an injury–. Notwithstanding, half of the patients reporting any sort of orofacial pain suffers chronically. And unlike acute receding pain, chronic pain is no longer a symptom, but a diffi cult-to-manage pathology, with scarce or none relation to the mechanisms that caused it. Moreover, the lack of appropriate anamnesis and clinical examinations, inaccurate pain syndrome nomenclatures or difficulty in diagnosis hamper sometimes an optimal therapeutic approach. Most oral pain classifications are still based on the affected anatomical structure rather than on the nociceptive mechanism itself. On the other hand, the precise aetiology of most of the so-called atypical algiae or the burning mouth syndrome is still unknown. The present review article aims to describe the main reasons for pain consultation at the dental clinic, with particular emphasis on the type of pain from a mechanistically point of view: nociceptive, inflammatory, neuropathic, psychogenic or mixed.