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It is the responsibility of the Orofacial Pain Specialist to diagnose pain in the head or neck and to manage this pain or when appropriate refer to another team member. The common facial pain disorders are:

• TMD ( TMJ)
• Headache
• Undiagnosed persistent toothache
• Ear Pain ( after ENT evaluation )
• Neck pain
• Sinus pain
• Trigeminal Neuralgia

TMD ( TMJ)

This is the most common disorder seen by the Orofacial Pain dentists and involves pain in the muscles that move the jaw or pain in the jaw joints (TMJs). It is predominantly found in females of child bearing age (85%)  Common signs of TMD are: *

• Limited opening or inability to close the mouth
• Joint sounds ( clicking, popping or sandy sounds when opening or biting down)
• Change in bite
• Headaches
• Cheekbone pain
• Toothache when eating other than dental pain
• Ringing in the ears ( tinnitus)
• Dizziness or vertigo
• Sinus pain
• Eye pain
• Sudden change in bite

*It needs to be emphasized that the above may be associated with TMD but can be caused by other disorders unrelated to TMD. For instance with tinnitus or ringing in the ears the cause is most often hearing loss.

Common TMD Diagnoses (management of TMD depends on accurate diagnosis and will described later )

Joint inflammation

Joint inflammation or joint pain is usually caused by excessive forces directed to the TMJs or jaw joints; for instance,  biting down too hard, clenching and grinding, injury to the jaw, or stretching the jaw  open for long periods of time ( for instance during a dental visit).

The pain is usually felt in front of or in the ears and closing the jaw or biting is painful.

Joint inflammation can be acute or chronic and different management is needed depending on how long the patient has been in pain.

Disc Displacements

Like any joint in the body there is a cartilage (disc)  between the jaw joint and the skull that the joint glides on. When this cartilage becomes displaced the first evidence of this  is usually painless clicking and popping during  opening and closing. This may ( but not necessarily) increase and become painful and may result in limited opening when the cartilage slip in front of the joint when opening. This is commonly called locking.

This most commonly occurs in females during the teen years and 20’s.

Painless clicking and popping can be benign does not necessarily progress and usually requires no treatment. I can go away spontaneously.

TMJ Arthritis

The jaw joint like any other joint in the body can be susceptible to arthritic changes. This can be the common osteoarthritis or in rare cases autoimmune such as rheumatoid arthritis. Although the exact cause of arthritis is not known excessive forces on joints certainly can implicated. Although TMJ arthritis can occur at any age it is usually more present in older patients.

Muscle Pain

Muscle Pain or pain in the muscles that move the jaw can be acute or chronic.

Acute muscle pain- Any person that uses the jaw excessively for a period of time such as chewing gum, talking, singing will experience pain and fatigue the jaw muscles. This usually lasts a short time and is easily treated by rest of the jaw, softer diet, ice and or moist heat.

Chronic muscle pain- chronic muscle pain usually is associated with one of 2 sources or both:

1.Referred pain from painful joints- this is the most common source and is resolved when joint pain is reduced

2.Myofascial pain- this is a chronic pain syndrome associated with “knots” or “trigger points” in the muscles referring to other structures in the head or neck. The exact cause of myofascial pain is unknown but believed to be a dysfunction of the central nervous system caused by prolonged pain, stress, anxiety, and in some cases medication use. It is the most difficult of the TMD disorders to manage and usually requires a team approach. Myofascial pain is not an overuse disorder and just resting the muscles will not reduce pain

Tendonitis

The tendons attaching the muscles that move the jaw to bone can often become painful when stretched or compressed. This is very similar to a common “tennis elbow” but in the mouth.

This disorder is related to eye pain, headache, cheek pain, sinus, pain and is often misdiagnosed.