Facial Pain

Primary causes of pain

 * Dentine sensitivity
 * pulpitis
 * periapical periodontitis
 * abscess
 * neuralgias

Neuralgias

 * Trigeminal neuralgia

Sharp stabbing episodic electric shock like pain; lasts a few sec

Trigger zone - stimulated by washing face/shaving etc.

Treated with carbamazepine 100mg 2x per day. Local anesthetic, injected to trigger zone can relief pain temporarily


 * Glossopharyngeal neuralgia

Posterolateral tongue and ear of affected side

stimuli : eating, drinking, speaking


 * Preherpetic neuralgia

Aching, burning pain, limited to distribution of trigeminal nerve

Treated with high dose acyclovir


 * Postherpetic neuralgia

Unpleasant burning pain.

Blockade of stellate ganglion with bupivicaine (local anesthetic) (short term relief)

Pain of vascular origin

 * migraine

Intense persisting aching pain, unilateral

Stimuli : food, alcohol, stress, hormones.

We give painkillers.

Intense aching pain that disturbs sleep, nasal congestion.
 * Cluster headache

Stimuli : alcohol, vasodilators, high altitude.

Treat with ergotamine or sumatriptan.


 * Giant cell Arteritis

Throbbing headache, unilateral, fever, malaise, weight loss

Treated with high dose prednisolone.

Atypical orofacial pain
Gripping, vice like aching pain, feeling of pressure

Burning mouth syndrome

 * type 1 (not present on waking)
 * type 2 (present on waking)
 * type 3 - intermittent - Possible deficiency of vitamin B1 and B6