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Orofacial Pain


The term orofacial pain (OFP) commonly refers to pain associated with the hard and soft tissues of the head, face, oral cavity and neck. An estimated 25% of the population has experienced some form of orofacial pain, with the highest prevalence in the 18- to 25-year-old age group. OFP may be due to disease of the orofacial structures, musculoskeletal system, peripheral or central nervous system, or possibly, the manifestation of psychosocial disorders. OFP can be primary in presentation or secondary due to referral from other sources such as cervical or intracranial structures. The diversity of these numerous structures and their complex innervations are potentially responsible for the sometimes puzzling symptomatology these patients present with. In many cases, OFPs can be categorized by their location and pain presentation. These presentations may include pain of dental origin or of the oral mucosal structures due to infection or inflammation, neurovascular disorders including post stroke pain, nerve trauma pain, idiopathic atypical pains, and finally musculoskeletal disorders including the temporomandibular joint and associated musculature. Temporomandibular disorders (TMDs) are the second most common pain presentation in the lower face behind dental and oral mucosal pains. It has been estimated that in adult populations, 40% to 75% of individuals have at least 1 sign of joint dysfunction, and nearly 33% have at least 1 symptom of TMD. Most cases of TMD are mild and self-limiting and tend to resolve over time without active treatment. Many patients who experience orofacial pains also tend to suffer with headache disorders. Due to the complex and shared neuronal mechanism of these disorders, an understanding of orofacial pains will ultimately prove beneficial to the headache clinician.

Overview of Orofacial Pain
Orofacial pain: a guide for the headache physician
Shephard, M.K., E.A. Macgregor, and J.M. Zakrzewska. Headache, 2014. 54(1): p. 22-39.

Temporomandibular disorders
Temporomandibular disorders, facial pain, and headaches
Bender, S.D. Headache, 2012. 52 Suppl 1: p. 22-25.

Headache and symptoms of temporomandibular disorder: an epidemiological study
Goncalves, D.A., et al. Headache, 2010. 50(2): p. 231-241.

Diagnostic criteria for screening headache patients for temporomandibular disorders
Schiffman, E., et al. Headache, 1995. 35(3): p. 121-124.

Facial pain and the second edition of the International Classification of Headache Disorders
Zebenholzer, K., et al. Headache, 2006. 46(2): p. 259-263.

Gender differences
The influence of gender and sex steroids on craniofacial nociception
Cairns, B.E. Headache, 2007. 47(2): p. 319-324.

Trigeminal neuralgia
Intravenous Lidocaine Treatment in Classical Trigeminal Neuralgia With Concomitant Persistent Facial Pain
Chaudhry, P. and D.I. Friedman. Headache, 2014. 54(8): p. 1376-1379.

Concomitant persistent pain in classical trigeminal neuralgia--evidence for different subtypes
Maarbjerg, S., et al. Headache, 2014. 54(7): p. 1173-1183.

Pretrigeminal neuralgia
Evans, R.W., S.B. Graff-Radford, and J.P. Bassiur. Headache, 2005. 45(3): p. 242-244.

Review article: the medical management of trigeminal neuralgia
Green, M.W. and J.E. Selman. Headache, 1991. 31(9): p. 588-592.

An observational trial to investigate the efficacy and tolerability of levetiracetam in trigeminal neuralgia
Mitsikostas, D.D., et al. Headache, 2010. 50(8): p. 1371-1377.

Nasal sumatriptan as adjunctive therapy for idiopathic trigeminal neuralgia: report of three cases
Shimohata, K., et al. Headache, 2009. 49(5): p. 768-770.

Subcutaneous sumatriptan for refractory trigeminal neuralgia
Kanai, A., M. Saito, and S. Hoka. Headache, 2006. 46(4): p. 577-582; discussion 583-584.

Atypical odontalgia
Atypical odontalgia: a review of the literature
Melis, M., et al. Headache, 2003. 43(10): p. 1060-1074.

Facial pain of dental origin
Facial pain of dental origin--a review for physicians
Heir, G.M. Headache, 1987. 27(10): p. 540-547.

Facial pain due to nerve injury
Lingual nerve injury
Graff-Radford, S.B. and R.W. Evans. Headache, 2003. 43(9): p. 975-983.

Post-traumatic external nasal pain syndrome (a trigeminal based pain disorder)
Rozen, T. Headache, 2009. 49(8): p. 1223-1228.

Facial pain and the central nervous system
Altered functional connectivity between the insula and the cingulate cortex in patients with temporomandibular disorder: a pilot study
Ichesco, E., et al. Headache, 2012. 52(3): p. 441-454.

Altered regional brain morphology in patients with chronic facial pain
Schmidt-Wilcke, T., S. Hierlmeier, and E. Leinisch. Headache, 2010. 50(8): p. 1278-1285.

Persistent idiopathic facial pain
Persistent idiopathic facial pain
Evans, R.W. and E. Agostoni. Headache, 2006. 46(8): p. 1298-1300.

Burning mouth
Characteristics of men and premenopausal women with burning mouth symptoms: a case-control study
Kim, Y., H.I. Kim, and H.S. Kho. Headache, 2014. 54(5): p. 888-898.

Burning mouth syndrome: a therapeutic approach involving mechanical salivary stimulation
de Souza, F.T., et al. Headache, 2012. 52(6): p. 1026-1034.

Topirimate-induced burning mouth syndrome
Friedman, D.I. Headache, 2010. 50(8): p. 1383-1385.

Facial neuropathy
Painful trigeminal neuropathy: clinical and pharmacological observations
Khurana, R.K. and R.F. Mayer. Headache, 1997. 37(8): p. 522-526.

Sympathetic nerve blocks for post herpetic neuralgia
Sympathetic nerve blocks in mandibular herpes zoster and postherpetic neuralgia
Gomes, R.T., et al. Headache, 2007. 47(5): p. 728-30.

About Steven D. Bender, D.D.S
Dr. Steven D. Bender earned his Doctorate of Dental Surgery degree from Baylor College of Dentistry, in 1986. He has completed postgraduate dental education at the L.D. Pankey Institute and the Dawson Center for Advanced Dental Study. He studied orofacial pain and temporomandibular disorders at the Parker E Mahan Facial Pain Center at the University Of Florida College Of Dentistry under the mentorship of Doctors Henry Gremillion and Parker Mahan.

Since 2001, Dr. Bender has maintained a private practice devoted to pain management of the head and face, as well as sleep medicine dentistry. He has earned Fellowship in the American Academy of Orofacial Pain, the American Headache Society, the International Academy of Oral Oncology and the American College of Dentists. He holds the office of president-elect of the American Academy of Orofacial Pain and is the president of the Fourth District Dental Society of Texas. Dr. Bender is a clinical assistant professor in the department of periodontics, Somatology Center at Texas A&M University Baylor College of Dentistry in Dallas, Texas. where he has started a facial pain clinic. He has published numerous articles in peer reviewed journals on the topics of sleep related breathing disorders, bruxism, headache and other related topics. He also serves as a reviewer for numerous medical and dental journals. He has lectured around the country on the topics of Dental Sleep Medicine, Anatomy, Facial Pain, Headache, Pharmacology, and Oral Medicine.

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