The mystery of facial pain
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Dentists occasionally encounter patients who suffer from an agonizing pain somewhere in the mouth which often includes areas of face and neck. After routine examination, however, nothing to justify the patient’s agony is found. Sometimes the dentist may then prescribe analgesics not being sure of what is causing the pain. But frequently, the pain either subsides mildly or not at all. The frustrated patient then seeks the help of another professional, only for the process to be repeated. However, any astute dentist will know that, in general, the diagnosis of facial pain is a complex process.

The initial step in the diagnosis of facial pain is a thorough medical history which should include a complete review of systems, a family history, social history, and a cursory of psychological evaluation. Special emphasis should be placed on disorders involving the head, neck, nose and throat because disorders affecting any of these areas may present with facial pain.

Patients with psychiatric or psychological problems could present either chronic or acute facial pain. It is not a simple task for a dentist to convince a patient that the painful sensation experienced in the face originates in the patient’s mind.

There are thirteen systemic disorders which are associated with facial pain. Ischaemic heart disease, for example, produces pain that may be referred to the left side of the jaw, especially causing the molars to ache. Persons with high blood pressure when undiagnosed or uncontrolled experience vascular headaches which often radiate to the neck region.

A nervous disease called multiple sclerosis often results in neuralgia, a fairly common condition. But the most significant positive findings involving connective tissue disorders are arthritis, systemic lupus erythematosus. This can affect the joints and muscles of the jaw resulting in myalgia (muscle ache) of the muscles involved in chewing. Arthritic involvement of the jaw joints and cervical spine can cause headache, neck pain and facial pain.

Significant historical findings involving the endocrine system include thyroiditis and low blood sugar. Common signs of thyroidism are muscle stiffness and myalgia; when undiagnosed this disease might act as a perpetuating factor in chronic facial pain.

Certain factors may aid in diagnosis. Pain that occurs after a traumatic or stressful episode often implies that the cause is related to emotional factors. Neuralgia is mostly found in persons over the age of 50, although younger persons can be affected. Jaw joint disorders mostly affect persons between the ages of 20 and 40 years.

It must be emphasised that the diagnosis and consequent management of facial pain is not necessarily a simple matter. A careful assessment should be done. Patients need to understand that the dentist may question about psychological status (social stresses etc. and medical conditions (heart diseases) to ascertain the exact condition and to arrive at the appropriate treatment. Finally, whenever a person has a pain that they believe is coming from a tooth but they are not sure which tooth it is, they should consider that the pain may not be originating from a tooth at all.

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