Dentistry has enjoyed a remarkable period of technological and scientific growth over the past several decades. With the increase in life expectancy, the number of individuals seeking dental care also has escalated. One of the most common reasons for seeking care is because of pain and/or dysfunction, usually involving the teeth or periodontal tissues. However, musculoskeletal, vascular, and neuropathic causes of orofacial pain occur frequently. The need to understand pain and all of its ramifications is of utmost importance in diagnosis and case-specific, evidence-based management of conditions afflicting the masticatory system.

   The most recent definition of pain, produced by the task force on taxonomy of the International Association for the Study of Pain (IASP) is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” . Orofacial pain encompasses a myriad of signs and symptoms within and outside the oral cavity. To establish a differential diagnosis for orofacial pain we must first consider the

history, examination and relevant investigations. Although both may co-exist, the more rare non-dental pain must be distinguished from dental pain to avoid unnecessary dental treatment and to organize appropriate referral for the patient.

Principles Of Pain Diagnosis

The examination and assessment of patients with chronic orofacial pain is challenging for all clinicians. In most disorders, no specific biologic marker validated diagnostic criteria or gold standard exists. A systematic approach for collecting diagnostic information is needed to minimize the risk of missing critical information. Identifying the true source of pain

History, physical examination, and behavioral assessment usually serve as the basis for diagnosis. Frequent re evaluation including assessment of the effects of treatment is an important part of this

Differentiating the many causes of facial pain can be difficult for busy practitioners, but a logical approach to history taking is important and will aid more rapid diagnoses with effective management. Although primary care clinicians are not be expected to diagnose rare pain conditions, they should be able to assess the presenting pain complaint and refer to the appropriate center. It is important that primary care practitioners provide sufficient detailed information of history, examination and investigation findings in their referral letters to ensure appropriate direction of the referral within the secondary/tertiary care institution. Underlying causes of orofacial pain are wide ranging and complex, but a greater understanding of a patient’s facial pain symptoms, towards establishing a diagnosis or differential diagnosis,

can be achieved by obtaining a good pain history and carrying out a good clinical examination.