Oral & Facial Pain

Oral and Facial Pain/Orofacial Pain Conditions

In oral and facial pain, pain is experienced in the mouth, jaw, face, temples, eyes, or ears.

Neuropathic (nerve) pain
Musculoskeletal (muscle and joints) pain
Neurovascular (a headache) pain

Trigeminal neuralgia, burning mouth syndrome, and other neuropathies of the face and mouth are examples of neuropathic pain. Dental procedures that are benign or surgical such as tooth extraction or implant placement can cause neuropathies in some patients.

Myofascial pain, TMJ pain, arthritis, and other conditions that affect the muscles and joints of the face and head are considered musculoskeletal pain.

Conditions that cause neurovascular pain, such as tension-type headaches, migraines and autonomic cephalgias, affect not just the head but also the face and mouth due to the trigeminal nerve. Autonomic cephalgias can be further broken down into cluster headaches, hemicrania continua, paroxysmal hemicrania and SUNCT. Should you wish to explore these conditions in depth, additional information is available on our website.

We recommend an evaluation by a fellowship-trained and board-certified specialist in orofacial pain due to the wide range of conditions that can cause facial pain.

What are treatment options to obtain relief from oral and facial pain?

Once an accurate diagnosis has been established for the orofacial pain condition, treatment options may include:

Nerve blocks of the different branches of the trigeminal nerve
Sphenopalatine ganglion blocks
Trigger point injections of muscles (such as trigger point muscle injections, nerve blocks, and botox®)
Medications (prescription nerve pain medications, muscle relaxants, etc.)
Prescription formulated topical creams and rinses

How are orofacial pain conditions diagnosed?

Orofacial pain conditions require comprehensive assessment. This includes obtaining a thorough history, as well as conducting a detailed, clinical examination of the cranial nerves and physical structures. For this purpose, a fellowship-trained and board-certified orofacial pain clinician such as Dr. Reddy & Dr. Kodali is best suited to identify the problem areas. Furthermore, tests like blood tests, brain MRI, face MRI, maxillofacial CT, head CT or x-rays of the jaw may be needed for an accurate diagnosis. In some cases, Dr. Reddy & Dr. Kodali may consult with medical specialists like ENTs, neurologists and rheumatologists in order to determine the best course of Orofacial pain treatment for you.

Treating Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia, also known as tic douloureux, is a severe and persistent condition that affects one or two branches of the trigeminal nerve. This vital nerve carries sensations to the face, jaw and teeth, with three primary branches providing stimulation to the upper, middle and lower parts of the face as well as within the oral cavity. Usually two of these branches - either the maxillary or mandibular - are affected by trigeminal neuralgia. As age progresses, this health problem becomes more common and can be caused by benign conditions such as myofascial pain or TMJ, but may also be associated with serious medical issues including tumor growths, strokes, multiple sclerosis and demyelinating disorders. In certain cases it might arise after surgical procedures or due to trauma.

What are the symptoms of trigeminal neuralgia?

Trigeminal neuralgia is one of the most powerful and intense pain states to live with. It causes sudden facial pain that can be electrical, burning or shock-like in nature. This type of pain generally affects only one side of the face and is triggered by a range of activities like light touching, brushing teeth, washing your face, applying makeup or cold wind. Although attacks are relatively short-lived, it is sometimes accompanied by a longer lasting sensation afterwards.

How is trigeminal neuralgia diagnosed?

It is necessary to schedule a consultation or comprehensive evaluation with a neurologist and/or trained orofacial pain specialist, such as Dr. Reddy & Dr. Kodali, in order to make a diagnosis. During the appointment, the doctor will do a full review of all your symptoms, which includes details about the type of pain you experience, where it is felt, and what brings it on, if anything does. The face will be examined to pinpoint the source of discomfort. An MRI may be ordered to detect if multiple sclerosis or some other problem is causing the pain. Other tests may also be ordered to eliminate other possible causes of the pain or affirm trigeminal neuralgia as the issue.

SUNCT / SUNA is a headache condition that shares many of the same features as trigeminal neuralgia. However, these two conditions can be difficult to tell apart. A medical expert in orofacial pain or neurology can help identify which type you have and suggest any necessary treatments. Our own Dr. Reddy & Dr. Kodali would be happy to provide guidance through this process.

What treatments are available for trigeminal neuralgia?

The initial approach to resolving trigeminal neuralgia is often to treat it with medications that are designed to target the nerves that are misfiring. This would not include opioids and can reduce or eliminate the abnormal nerve firing. If this does not yield satisfactory results, further therapies may be employed, such as nerve blocks and Botox® injections, which are able to stop the triggering areas from causing an attack. If these treatments do not offer enough pain relief, specially tailored topical medical agents from a pharmacist can be used. Lastly, if none of these methods work, a neurosurgeon's intervention might be necessary in order to obtain some relief. Dr. Reddy & Dr. Kodali will collaborate with your medical team in order to create the best plan for long-term freedom from symptoms.