Principles & Practice of Pain Medicine > Part IV. Pain by Anatomic Location > A. Head and Neck > Chapter 26. Orofacial Pain David A. Keith

Characteristic Features of Oral and Facial Pain

"This category includes the greatest number of oral and facial pains encountered in clinical practice. By means of a careful history and appropriate tests, the etiology can be determined.Pain arising from the teeth, supporting structures, and jaws usually is diagnosed accurately by the patient. Hypersensitivity of a tooth as a result of an exposed root surface or a recent deep restoration is described as sharp, usually transient, and well localized. It is aggravated by hot, cold, or sweet foods. A cracked tooth also may cause transient sharp pain on biting. This may be difficult to identify and lead to an erroneous diagnosis. If the pulp is involved in an inflammatory reaction resulting from dental caries, the pain is spontaneous, severe, and less well localized. Heat aggravates and cold relieves the pain; it may persist for minutes or hours. In time, the pain stops, indicating complete necrosis of the pulpal tissue. This may progress to a periapical abscess in which signs of infection are present, and the tooth is tender to bite on and to percussion. Endodontic treatment will save the tooth and eliminate the infection. Facial neuralgias include the primary idiopathic neuralgias. These have been recognized for many centuries and are among the most severe pains felt by humans. The features of trigeminal neuralgia are well described.²³ Characteristically, there is a trigger zone in the area of the nasolabial fold or upper or lower lip. When stimulated by washing, shaving, talking, or any slight movement,..."