Key Points
Orofacial pain remains a prevalent and debilitating condition that exerts a significant social and economic impact on patients and the health care system.
Many of the risk factors associated with temporomandibular disorders (TMDs) involve mechanical, chemical, or environmental stressors that increase the likelihood of developing and maintaining a chronic pathologic state.
Sensitization and activation of trigeminal nerves and the subsequent development of peripheral and central sensitization are key pathophysiologic events leading to allodynia and hyperalgesia.
Glial cells play an important role in the transition of acute to chronic pain by modulating the excitability state of nociceptive neurons in the trigeminal ganglion and spinal cord.
Epigenetic influences on gene expression, mediated by our lifestyle and environment, significantly impact the progression of TMD and migraine pathology, necessitating comprehensive therapy.
In March 2020, the National Commission on Recognition of Dental Specialties and Certifying Boards officially recognized Orofacial Pain as the dental profession s 12th specialty.
Discoveries from the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) study have helped to clarify specific risk factors and genes implicated in the development of TMDs.
Given the complex multifactorial etiology of orofacial pain conditions, management may require multiple interventions, such as but not limited to pharmaceuticals, physical therapy, oral appliances, behavioral modifications, diet modifications, and forms of exercise that emphasize proper breathing and increasing flexibility.
The COVID-19 pandemic has had a major impact on the healthcare community and has driven advances in digital technology such as the use of telemedicine, phone apps, and other electronic aids that will forever change the medical landscape.
The Spectrum of Orofacial Pain
Orofacial pain refers to pain disorders of the jaw, mouth, face, head, and neck. These anatomical regions comprise an array of widely diverse structures and tissues ranging from dental pulp to the meninges of the brain. Pain conditions associated with these structures may derive from local factors or involve systemic, autoimmune, infectious, traumatic, or neoplastic pathologies. These conditions include odontogenic and periodontal pains, musculoskeletal disorders such as temporomandibular disorders (TMDs), headache and neurovascular pains, vascular disorders, and neuropathic pains.
Underlying this kaleidoscope of pain possibilities is a unifying system, the trigeminal sensory complex, in which impulses from the head and neck are conveyed by the branches of the trigeminal and upper cervical nerves to the trigeminal sensory nucleus in the brain stem. These impulses are modified by input originating within the trigeminal system and from higher regions of the central nervous system (CNS). Multiple areas of the brain process and interpret this input, giving rise to the sensation of pain and facilitating physiologic/adaptive responses, including behavioral changes.1
The diversity and complexity of orofacial pain conditions have led to recognition of the need for a specialized field of dentistry and for collaboration among multiple fields of medicine to improve care for patients afflicted with these disorders.
The Specialty of Orofacial Pain
Orofacial pain as a specialty has made significant strides in recent years. In 2009, the Commission on Dental Accreditation (CODA) approved orofacial pain as an area of advanced education, and since 2011, multiple residency and fellowship programs have been accredited in the United States. The International Association for the Study of Pain (IASP) has recognized the need for orofacial pain education by developing a core curriculum on this subject for health
