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Differential diagnosis for orofacial pain, including sinusitis, tmd, trigeminal neuralgia Anne M Hegarty Joanna M Zakrzewska Dental Update 2024 38:6, 707-709.
Authors
Anne MHegarty
BDentSc, MSc(OM), MBBS, MFD, RCSI, FDS(OM) RCS
Consultant and Honorary Clinical Lecturer in Oral Medicine, Charles Clifford Dental Hospital, Sheffield S10 2ZS
Professor of Pain in Relation to Oral Medicine, Clinical and Diagnostic Oral Sciences Dental Institute, Barts and the London Queen Mary's School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
Correct diagnosis is the key to managing facial pain of non-dental origin. Acute and chronic facial pain must be differentiated and it is widely accepted that chronic pain refers to pain of 3 months or greater duration. Differentiating the many causes of facial pain can be difficult for busy practitioners, but a logical approach can be beneficial and lead to more rapid diagnoses with effective management. Confirming a diagnosis involves a process of history-taking, clinical examination, appropriate investigations and, at times, response to various therapies.
Clinical Relevance: Although primary care clinicians would not be expected to diagnose rare pain conditions, such as trigeminal autonomic cephalalgias, they should be able to assess the presenting pain complaint to such an extent that, if required, an appropriate referral to secondary or tertiary care can be expedited. The underlying causes of pain of non-dental origin can be complex and management of pain often requires a multidisciplinary approach.
Article
Management of orofacial pain can only be effective if the correct diagnosis is reached and may involve referral to secondary or tertiary care. The focus of this article is differential diagnosis of orofacial pain (Table 1) rather than available therapeutic options.
(This list is not exhaustive)
TAC = Trigeminal autonomic cephalalgia
SUNCT = Short-lasting, Unilateral, Neuralgiform headache with Conjunctival injection and Tearing
The underlying cause of the majority of facial pain presentations in primary care will be of a dento-alveolar origin. These will not be discussed further here but their differentiating features are summarized in Table 2.
URTI = upper respiratory tract infection
TMD = temporomandibular disorder
BMS = burning mouth syndrome
TN = trigeminal neuralgia
CIFP = chronic idiopathic facial pain
SUNCT = Short-lasting, Unilateral, Neuralgiform headache with Conjunctival injection and Tearing/SUNA Short-lasting, Unilateral, Neuralgiform headache with Autonomic features
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