Facial pain is common among adults. It is often associated with headaches and non-specific pain related to dental origin. However, other causes of facial pain include nerve conditions, jaw issues and other infections. Facial pain can originate from a specific area of the face, or it may radiate from another part of the head or oral cavity.
Dentists and physicians often categorize facial pain into one of several types, including:
• Dental pain, relating to problems with the teeth and gums.
• Nerve pain, or neuralgia, relating to conditions that affect the nerves of the face.
• Temporomandibular pain, relating to the temporomandibular joint (TMJ) and the muscles of the jaw.
• Vascular pain, which occurs due to issues with blood vessels and blood flow.
Because facial pain can be caused by so many different reasons, a diagnosis from a dental origin can be challenging at times.
In this column, we will discuss facial pain and how it is commonly associated with dental disease and injury.
Dental abscesses from gum disease infections are very common. They appear as pain and swelling on one side of the face. Patients often cannot pinpoint them despite them being on a certain side of the face. A gum abscess occurs when a gum pocket becomes trapped with debris or bacterial plaque and cannot be drained. There is increased temperature and the body releases enzymes and proteins to fight the infection. The result is pus, swelling, pain and bone loss. The underlying bone is destroyed and the tooth gets shaky. Treatment is usually antibiotics and/or drainage of the pus followed by prompt treatment by a periodontist or a dentist with experience in gum diseases. Abscesses can cause a throbbing pain that may radiate to the jaw, face and neck.
Dental abscesses caused by damage to the nerve of a tooth are also very common. This type of infection is also associated with intense, radiating pain. This is referred to as a “toothache” because it directly involves the nerve of the offending tooth. These infections can occur when tooth decay, or injuries that damage teeth, allow bacteria to get inside the tooth. The nerve is damaged by trauma or plaque-related infection caused by a cavity. Intense pain is usually the result. Both abscesses from gum disease and a cavity/trauma should be treated immediately by an experienced dentist. Antibiotics, followed by a root canal and comprehensive treatment, is the treatment of choice; or an extraction. Many of the symptoms are consistent with the above symptoms of gum abscesses.
Trigeminal neuralgia is considered one of the worst pains known to medicine. It is caused by the fifth cranial nerve called the trigeminal nerve. Its constant nerve irritation results in what appears to be a “massive toothache”. This pain, because of its intensity, causes patients to do desperate things. Over the years, frustrated patients have seen many dentists thinking their pain is coming from a specific tooth. If the dentist is unfamiliar with the unique circumstances surrounding this syndrome, they usually extract a tooth, thinking it’s the culprit. The pain does not go away. They often see another dentist and again a tooth is removed. It is not until a specific diagnosis is made, that the patient learns that the jaw pain is not the cause of the problem. The problem is caused by the mis-firing of the nerve. Because this nerve is directly associated with the upper/lower jaw and on the face, it gives the impression that it is of dental origin. The pain tends to come on suddenly and ranges from a constant aching or burning sensation to a severe stabbing pain. Performing certain movements or actions such as eating, brushing the teeth and applying makeup can trigger a painful episode.
This unique pain is only managed when effectively diagnosed by a dentist or a medical doctor with experience in such matters. Causes of trigeminal neuralgia can include:
• Compression or pressure on the trigeminal nerve.
• Nerve damage from injuries, stroke or facial surgery.
• Underlying medical conditions, such as multiple sclerosis.
Treatment options for trigeminal neuralgia include:
• Avoiding the known triggers.
• Taking prescription medications, such as anticonvulsants, antidepressants and botulinum toxin (Botox) injections.
• Undergoing surgery in rare cases.
Temporomandibular joint (TMJ) pain is caused by the pain in the “jaw joint” just in front of the ear. Symptoms of a TMJ disorder can include:
• Jaw pain that may radiate to the face, head or neck.
• Stiffness in the jaw muscles.
• Difficulty opening and closing the mouth, which can include jaw locking.
• An uncomfortable clicking, popping or grinding when moving the jaw.
Treatments for TMJ disorders depend on the severity of a person’s symptoms, but can include:
• Taking over-the-counter and prescription pain relievers.
• Stress reduction techniques.
• Wearing a mouth splint or bite guard.
• Undergoing surgery to correct jaw alignment.
Constant facial pain can be disruptive to your quality of life. The key to successfully managing facial pain is a proper diagnosis. Because facial pain can be unusual in its presentation, it is important to see an experienced dentist or physician for an opinion. With the proper diagnosis and prompt treatment, you can be relieved of pain, preserve your dentition and enjoy good dental health and wellness.
• Dr. Kendal V.O. Major is the founder and CEO of the Center for Specialized Dentistry, which is a comprehensive family dental practice operating in New Providence and Grand Bahama. He is the first Bahamian specialist in gum diseases and dental implants since 1989. He is also a certified fast braces provider. His practice is located at 89 Collins Avenue, New Providence. He can be contacted at (242) 325-5165 or firstname.lastname@example.org.