2.838 4.

Editorial

Orofacial Pain, Diagnosis and

Treatment

Yaron Haviv

Special Issue
Orofacial Pain: Diagnosis and Treatment
Edited by
Dr. Yaron Haviv

https://doi.org/10.3390/app122111026
 applied
sciences
Editorial
Orofacial Pain, Diagnosis and Treatment
Yaron Haviv
Citation: Haviv, Y. Orofacial Pain,
Diagnosis and Treatment. Appl. Sci.
2022, 12, 11026. https://doi.org/
10.3390/app122111026
Received: 22 October 2022
Accepted: 27 October 2022
Published: 31 October 2022
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Appl. Sci. 2022, 12, 11026. https://doi.org/10.3390/app122111026
Department of Oral Medicine, Sedation & Maxillofacial Imaging, Faculty of Dental Medicine, Hadassah Medical
Center, Hebrew University of Jerusalem, Jerusalem 9190501, Israel; yaronha@hadassah.org.il
I am pleased to introduce this Special Issue on “Orofacial pain, diagnosis and treatment”.
Pain signals harm and induces behavioral changes, and chronic pain has a considerable
emotional component [1]. The definition of pain, according to International Association for
the Study of Pain (IASP), is “an unpleasant sensory and emotional experience associated
with, or resembling that associated with, actual or potential tissue damage”. This definition
demonstrates the evaluative and descriptive complexity of pain [2].
Pain involving the head, face, neck or intraoral structures is known as orofacial pain,
and can be acute or chronic [3,4]. OFP can be mixed with headaches or involve other organs
than those of the orofacial area. After ruling out primary causes of pain, such as dental
or periodontal lesions, trauma, sinusitis, salivary gland issues, tumors (local or remote),
systemic diseases, etc., we can consider the orofacial pain prototype.
Epidemiological studies have demonstrated that up to a quarter of the population
report orofacial pain (excluding dental pain), and up to 11% experience chronic orofacial
pain (OFP) [5]. OFP syndromes are associated with significant morbidity and high levels of
healthcare utilization [6].
OFP can generally be categorized as one of three major classes [6]:
(i) Temporomandibular disorders (TMD):
Temporomandibular disorders (TMDs) are conditions characterized by musculoskele-
tal pain and dysfunction in the temporomandibular joint (TMJ) and/or masticatory muscles,
and represent the most common chronic orofacial pain conditions [7,8]. According to the
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) [9], masticatory my-
ofascial pain can: be localized to the site of palpation; spread beyond the site of palpation
but remain confined to the muscle boundaries; or be referred. Pain is usually self-limited
with complete remission of symptoms, and thus, conservative reversible treatment is the
preferred strategy [10]. However, in about one third of patients, it can become chronic and
persistent [11]. Typical myofascial pain is unilateral, located at the angle of the mandible
and pre-auricular area; it is of moderate intensity and possesses a dull, pressing quality.
Pain tends to increase with function, and there may be associated limitation in the range of
mandibular movement [12].
(ii) Neuropathic pain:
Neuropathic pain is caused by damage or injury to the nerves. It can originate from
the central nervous system, as is the case for trigeminal neuralgia (TN), a severe unilateral
pain disorder characterized by brief, electric-shock-like pain attacks in the trigeminal nerve
distribution, mostly in the mandibular and maxillary brunches [13]. Damage to the periph-
eral nervous system can result in painful post-traumatic trigeminal neuropathy (PPTN) [14]
(e.g., nerve damage after routine dental treatment such as endodontic treatments or ex-
tractions). Viral infections can be the origin of neuropathic long-lasting pain, as is the case
for Post Herpetic Neuralgia (PHN), which is caused by secondary herpes zoster infection.
Sometimes, the underlying cause of the pain is enigmatic. An example of a syndrome of
unknown origin is Burning Mouth Syndrome (BMS), characterized by an intraoral burning
or dysesthetic sensation, without evident causative lesions upon clinical examination and
investigation [15].
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(iii) Neurovascular pain:

Neurovascular pain is a general term comprising several pain types with related char-
acteristics. Migraine is the most common headache disorder, usually starting at a young age
and with higher occurrence in females. Neurovascular orofacial pain (NVOP) [16] is a form
of migraine-like pain in the orofacial region. Trigeminal Autonomic Cephalalgias (TACs)
are primary headaches characterized by strictly unilateral pain with accompanying auto-
nomic symptoms; TACs include: cluster headache, paroxysmal and hemicrania continua
and SUNCT (short-lasting, unilateral, neuralgiform headache attacks with conjunctival
injection and tearing) [4].
After considering a differential diagnosis and ruling out possible secondary reasons,
the treatment of primary OFP may proceed. However, in cases of chronic pain, we rarely
treat; the preferred word is “management” [6]. Common management options may include
pharmacologic therapy; this can be an abortive therapy such as NSAIDS, or prophylactic,
which usually includes anti-depressants, anti-epileptics, or other drug families such CGRP
receptor antagonists, antihypertensive drugs, cannabis, etc. Other treatment modalities
may include physiotherapy (at home or in the presence of a professional), medical de-
vices such as dental night guards [17], TENS or ultrasound, trigger point injections, the
botulinum toxin, psychological aid such as cognitive behavioral therapy (CBT), surgery or
arthrocentesis (TMJ-oriented), or complementary medicine.
OFP and headaches can arise from any of the structures in the head and neck area,
which are in close proximity to each other. The underlying anatomical complexity of the
region causes diagnostic and therapeutic challenges.
Pain and orofacial pain specialists, neurologists, ENT specialists and dental practition-
ers form the target audience of this Special Issue. I am certain that the accepted manuscripts
will advance the understanding and treatment of orofacial pain.

Funding: This research received no external funding.

Conflicts of Interest: The author declares no conflict of interest.

References
1. Haviv, Y.; Mazor, S.; Shani, M.; Yanko, R.; Aframian, D.J.; Zadik, Y.; Ben-David, S.; Wilensky, A.; Sharav, Y. The Impact of
Expectation for Pain Relief on Orofacial Pain Treatment Outcomes. Front. Psychiatry 2021, 12, 734986. [CrossRef] [PubMed]
2. Raja, S.N.; Carr, D.B.; Cohen, M.; Finnerup, N.B.; Flor, H.; Gibson, S.; Keefe, F.J.; Mogil, J.S.; Ringkamp, M.; Sluka, K.A.; et al. The
revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain 2020, 161,
1976–1982. [CrossRef] [PubMed]
3. Orofacial Pain Classification Committee. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia 2020, 40,
129–221. [CrossRef] [PubMed]
4. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache
Disorders, 3rd edition. Cephalalgia Int. J. Headache 2018, 38, 1–211. [CrossRef] [PubMed]
5. Macfarlane, T.V.; Kincey, J.; Worthington, H.V. The association between psychological factors and oro-facial pain: A community-
based study. Eur. J. Pain 2002, 6, 427–434. [CrossRef]
6. Sharav, Y.; Benoliel, R. Orofacial Pain and Headache, 2nd ed.; Quintessence: Chicago, IL, USA, 2015.
7. Tjakkes, G.H.; Reinders, J.J.; Tenvergert, E.M.; Stegenga, B. TMD pain: The effect on health related quality of life and the influence
of pain duration. Health Qual. Life Outcomes 2010, 8, 46. [CrossRef] [PubMed]
8. Maixner, W.; Diatchenko, L.; Dubner, R.; Fillingim, R.B.; Greenspan, J.D.; Knott, C.; Ohrbach, R.; Weir, B.; Slade, G.D. Orofacial
pain prospective evaluation and risk assessment study—The OPPERA study. J. Pain 2011, 12, T4–T11. [CrossRef] [PubMed]
9. Schiffman, E.; Ohrbach, R.; Truelove, E.; Look, J.; Anderson, G.; Goulet, J.P.; List, T.; Svensson, P.; Gonzalez, Y.; Lobbezoo, F.; et al.
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of
the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Groupdagger. J. Oral Fac. Pain Headache
2014, 28, 6–27. [CrossRef] [PubMed]
10. Romero-Reyes, M.; Uyanik, J.M. Orofacial pain management: Current perspectives. J. Pain Res. 2014, 7, 99–115. [CrossRef]
[PubMed]
11. Rammelsberg, P.; LeResche, L.; Dworkin, S.; Mancl, L. Longitudinal outcome of temporomandibular disorders: A 5-year
epidemiologic study of muscle disorders defined by research diagnostic criteria for temporomandibular disorders. J. Orofac. Pain
2003, 17, 9–20. [PubMed]
Appl. Sci. 2022, 12, 11026 3 of 3

12. Kino, K.; Sugisaki, M.; Haketa, T.; Amemori, Y.; Ishikawa, T.; Shibuya, T.; Sato, F.; Amagasa, T.; Shibuya, T.; Tanabe, H.; et al.
The comparison between pains, difficulties in function, and associating factors of patients in subtypes of temporomandibular
disorders. J. Oral Rehabil. 2005, 32, 315–325. [CrossRef] [PubMed]
13. Haviv, Y.; Khan, J.; Zini, A.; Almoznino, G.; Sharav, Y.; Benoliel, R. Trigeminal neuralgia (part I): Revisiting the clinical phenotype.
Cephalalgia Int. J. Headache 2016, 36, 730–746. [CrossRef] [PubMed]
14. Haviv, Y.; Zadik, Y.; Sharav, Y.; Benoliel, R. Painful traumatic trigeminal neuropathy: An open study on the pharmacotherapeutic
response to stepped treatment. J. Oral Fac. Pain Headache 2014, 28, 52–60. [CrossRef]
15. Findler, M.; Michaeli, E.; Haviv, Y. Burning Mouth Syndrome—A Flame Hard to Extinguish. Harefuah 2016, 155, 506–509.
16. Haviv, Y.; Zini, A.; Keshet, N.; Almoznino, G.; Benoliel, R.; Sharav, Y. Features of Neurovascular Orofacial Pain Compared to
Painful Posttraumatic Trigeminal Neuropathy. J. Oral Fac. Pain Headache 2020, 34, 121–128. [CrossRef] [PubMed]
17. Almoznino, G.; Barsheshet, S.; Mazor, S.; Yanko, R.; Sharav, Y.; Haviv, Y. Long-term adherence to oral stabilization splints: Does
pain matter? Quintessence Int. 2021, 53, 68–76. [CrossRef] [PubMed]