THE first step in the clinical analysis of facial aching is to determine whether the discomfort is a referred toothache or a pain originating from a face structure. This includes but is not restricted to systems review, family medical history and psychological assessment. Emphasis must involve disorders involving the neck, head, throat and nose.

Dentists occasionally encounter patients who suffer from an agonising pain somewhere in the mouth, which often includes areas of the face and neck. After routine examination, however, nothing to justify the patient’s agony is found.

The dentist may then prescribe analgesics, unsure 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.

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 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 condition which is common. But the most significant positive finding involving connective tissue disorders are arthritis and systemic lupus erythematosus. This can affect the joints and muscles of the jaw, resulting in myalgia (muscle ache) in the muscles involved in chewing. Arthritic involvement of the jaw joints and cervical spine can cause headaches, 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 50, although younger persons can be affected. Jaw joint disorders mostly affect people 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 made. Patients need to understand that the dentist may question their psychological status (social stresses, etc.) and medical conditions (heart diseases) to ascertain the exact condition and 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 originate from a tooth.