One of the challenges that doctors face in talking about pain of the face and mouth, what we call orofacial pain, is that not everyone uses the same terms. We’re not just talking about how some people might call temporomandibular joint disorders TMJ while others use TMD.
Instead, we’re talking about doctors who are trained in different places and might have a different understanding of the types of facial pain, their causes, proper diagnosis, and recommended treatment. This can delay diagnosis and treatment, and can even lead to misdiagnosis, especially when cases are referred between doctors. To try to overcome this problem, the International Headache Society (IHS) recently published new guidelines on how to describe the different types of orofacial pain.
This new language, called the International Classification of Orofacial Pain (ICOP), identifies 6 different categories of orofacial pain, which can be helpful to you in talking to your doctor about your facial pain. Here are the different types of orofacial pain since it can help you communicate your symptoms to your dentist or doctor.
Pain Related to Teeth, Gums, and Mouth
The first type of orofacial pain they talk about is related to the teeth and other related structures in the mouth. They further break this down into two types of pain: dental pain and pain related to other structures in the mouth.
Dental pain can come in three types. The first type comes from the tooth pulp, the living part that includes the tooth nerve. The second type is periodontal pain, from the area around the tooth, including the periodontal ligament and the bone around the tooth. Finally, tooth pain could come from the gums around a tooth.
In addition to teeth, mouth pain could come from the mucosa, which is most of the surface of the mouth. It could also be related to the salivary glands. Sometimes there is also pain in the jaw bone.
Pain in the Face
Facial muscle pain, called myofascial orofacial pain in the classification system comes in just two types, either primary, which is not clearly related to other causes, or secondary, which has a clear cause in another condition. Primary myofascial orofacial pain is described as being either acute–sudden onset and short duration–or chronic–long duration.
Secondary facial pain might be linked to muscle spasms or the swelling of the tendons or muscles.
Temporomandibular Joint Pain
Like facial muscle pain, temporomandibular joint pain is divided into two types: primary and secondary. Primary TMJ pain is also divided into acute and chronic types.
Secondary TMJ pain can be potentially related to several different causes, including arthritis, displacement of the cushioning disc in the joint, degeneration of the joint, or subluxation. Subluxation is when opening the jaw joint too wide puts the cushioning disc out of place, which can make it hard for the disc to go back into place. In addition to being painful, this can make the jaw lock.
Nerve Related Pain
Some pain in the face is linked to injury or disease of certain nerves. The two main nerves that cause pain in this region are the trigeminal nerve and the glossopharyngeal nerve.
We’ve talked about the trigeminal nerve often because of its role in migraines and because trigeminal neuralgia is often confused with TMJ. Because of its location and structure, the trigeminal nerve can also be irritated or overstimulated as part of TMJ.
The glossopharyngeal nerve carries sensation from the tongue and throat, as well as helping to control those structures.
Orofacial Pain Similar to Headaches
The ICOP recognizes that facial pain is closely linked to headache disorders. Sometimes, the one might cause the other. Other times, the symptoms might overlap to the degree that it’s hard to distinguish between the conditions. The ICOP looks at four types of headache-like pain:
- Migraine-like pain
- Tension headache-like pain
- Trigeminal pain attacks
- Neurovascular orofacial pain
Migraine-like pain is divided into episodic and chronic types, just like true migraines. Trigeminal pain attacks have four different forms, some of which are quite rare, but may impact from small regions of the face up to affecting half the face. Neurovascular pain is classified depending on whether it is short-lasting or long-lasting.
“Inexplicable” Pain
Finally, the ICOP recognizes that it isn’t always possible to figure out why a certain pain occurs. This does not make that pain any less real. This is called “idiopathic” pain. Types of idiopathic pain in the ICOP are:
- Burning mouth syndrome
- Persistent idiopathic facial pain
- Persistent idiopathic dentoalveolar pain (related to the teeth)
- Constant unilateral facial pain with additional attacks
As you can tell from the lack of straightforward names, these types of pain are fairly specific, linked to certain types of symptoms, often without clear explanations as to why these types of pain occur.
Psychosocial Dimensions of Pain
The ICOP recognizes that pain can have significant interplay with psychosocial conditions, so it recommends proper assessment of this dimension of pain. Remember: the fact that your facial pain is linked to a psychosocial condition doesn’t make your pain unreal–it means that your pain is more multidimensional than simple physical pain.
Assessment of psychosocial aspects of pain can improve understanding and treatment of facial pain.
Comprehensive Evaluation and Relief of Pain in Denver
The ICOP system helps clarify the types of facial pain. Although we don’t treat all these types of pain, we have experience with them all, and if we can’t help you with your type of pain, we can refer you to someone who can.
If you are in Denver and are looking for a TMJ dentist to help evaluate your pain so you can find relief, please call (303) 691-0267 today for an appointment with a TMJ dentist at the TMJ Therapy & Sleep Center of Colorado.
