The management of patients with diseases of the oral soft tissues, oral cancer care, and oral cancer therapy complications, facial pains and temporomandibular disorders (TMD), atypical conditions such as sensory and motor dysfunctions of the jaws, salivary disorders, and behavioral medicine as relates to oral symptoms and conditions.

What is orofacial pain?
Orofacial pain refers to pain felt in the mouth, jaws, face, head, and neck, often without an obvious dental cause (e.g., not a cavity or abscess). It is a subspecialty recognized by the American Dental Association.

Common orofacial pain conditions:

1. Temporomandibular disorders (TMD):
Disorders of the jaw joints (TMJs) and chewing muscles.

• Symptoms: Jaw clicking or popping, pain when chewing, limited mouth opening, headaches, ear pain, neck and shoulder tension.

• Causes: Bruxism (teeth grinding), arthritis, trauma, stress.

• Treatment: Night guards, physical therapy, muscle relaxants, stress reduction, trigger point injections. In rare cases, surgery.

2. Burning mouth syndrome (BMS):
Chronic burning sensation in the mouth without visible lesions.

• Affects 1–3% of adults, mainly postmenopausal women.

• Cause unknown; may be neuropathic or related to nutritional deficiencies.

• Treatment: Alpha-lipoic acid, clonazepam, cognitive behavioral therapy.

3. Trigeminal neuralgia:
Severe, electric-shock-like facial pain along the trigeminal nerve.

• Considered one of the most painful conditions in medicine.

• Triggers: Brushing, talking, wind, light touch.

• Treatment: Carbamazepine, gabapentin, nerve blocks, or microvascular decompression surgery.

4. Salivary gland disorders:

• Xerostomia (dry mouth): Causes include medications (over 500 drugs), Sjögren’s syndrome, radiation therapy. Complications: Increased cavities, oral thrush, difficulty swallowing.

• Sialolithiasis (salivary stones): Painful swelling during eating.

• Treatment: Hydration, sialagogues (lemon drops), stone removal, or surgery.

Oral cancer and oral medicine:
Oral cancer (mostly squamous cell carcinoma) affects the lips, tongue, cheeks, floor of the mouth, and throat.

• Risk factors: Tobacco (including smokeless), heavy alcohol use (synergistic risk), HPV-16 infection, immunosuppression.

• Signs: Non-healing ulcer ( >2 weeks), red/white patch, lump, numbness, difficulty swallowing.

• Survival rate: 85% if detected early; 40% if detected late.

• Screening: Visual and tactile exam at every dental visit.

Statistics:

• Approximately 5–12% of the population suffers from chronic orofacial pain (Journal of Orofacial Pain).

• TMD affects nearly 10 million people in the U.S. alone.

• Oral cancer diagnoses: 54,000 new cases and 11,000 deaths annually in the U.S. (American Cancer Society).

• Only 30% of oral cancers are caught at an early stage.

Treatment approaches at Elite Smile:

• Medications (NSAIDs, tricyclic antidepressants, anticonvulsants)

• Intraoral appliances (night guards, stabilization splints)

• Physical therapy (jaw exercises, manual therapy)

• Cognitive behavioral therapy (for chronic pain management)

• Biopsy and referral for oral cancer treatment

• Saliva substitutes and prescription fluoride for dry mouth

References:

• Okeson, J.P. “Management of Temporomandibular Disorders and Occlusion.” 8th ed., Elsevier, 2019.

• Benoliel, R., et al. “Orofacial pain and headache.” J Oral Facial Pain Headache, 2017.

• American Cancer Society. “Oral Cavity and Oropharyngeal Cancer Statistics.” 2022.