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7-Headache and Facial Pain

7-Headache and Facial Pain

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Published by: shanfiza_92 on Apr 24, 2013
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Headache and facial pain
Abeer Derawi
Headache and facial pain
For you as dental students
it’s very important to understand what is f 
acial painrather than teeth, usually facial pain categorized in one of these classifications:
Secondary to pain of tooth origin
Pain of Muscle and Joint Origin
Pain of Nerve Origin
Headache including Migraines (tension & cluster headache )
Others :Eyes, ears, sinus, parotid gland( otitis media, orbitalcellulitis,sinusitis and mumps)
1) Pain of Muscle and Joint Origin:
Usually we have pain of temporomandibular joint may occur in 10% of the US population, most of them have it as a chronic period rather than an acute one.TMJ anatomy
Look at the figure bellow you can see the synovial cavity which is very important,here most of the pathophysiology would occur for the TMJ; we have the condyle of the mandible that is resting in the temporal bone and it forms a synovial joint whichis a capsulated joint with a synovial fluid inside , so if we have any of thesecomponents inflamed we will have TMJ inflammation.
So ,,, Temporomandibular joint (TMJ)
is the site of articulation between the mandiblar condyle and the skull, usually acts to open and close your mouth, specifically thearticular eminence of the temporal bone.The articulation consists of parts of the mandible and temporal bones, which arecovered by dense, fibrous connective tissue and surrounded by several ligaments.-
We have several pairs of muscles attached to the mandible produce themovements (muscles of mastication): medial pterygoid ,lateral pterygoidtemporalis and the maseter.-
The nerve which supply it is the mandibular division of the trigeminal nerve
 It's not only a motor,
also a major sensory of the face, it has pain-sensitiveelements within the TMJ inside the synovial capsule, so if this capsule becomeinflamed theV3 would actually has sensation , this is an implication for you,because as you remember V3 has the inferior alveolar nerve which the one thatresponsible for innervation of the mandible and the lower teeth so sometimesTMJ patients although they have a localized TMJ pain but also being supplied byV3 (inferior alveolar nerve branch) so it may radiate t
o the lower jaw !{ it’s an
important one of the differential diagnoses in the lower teeth that you shouldkeep in mind}
So it’s actually an
inflammation within the joint accounts for TMJ pain, and thedysfunction is caused by a disk-condyle incoordination.
It starts as inflammation that cause irritation at the TMJ , this TMJ pain wouldmake you not able to open your mouth properly and this will make the disk-condyle incoordination , this is the secondary effect of the problems of TMJ.{keep in mind that it may radiate to the lower jaw !}The etiology for TMJ usually include parafunctional behaviors, macrotraumas or microtraumas, changes in the occlusion, and behavioral influences. Sometimes patients may have anteriorly located articulation of TMJ with the temporal bone,sometimes even a trauma cause TMJ pain .
Known as a
disk derangement disorder
, articular disk displacement is the mostcommon temporomandibular arthropathy and is characterized by an abnormal

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