Orofacial Pain Treatment

The complexity & complications

The Problems with Orofacial Pain Treatment

A proper diagnosis is essential for effective orofacial pain treatment, yet it can be tricky to determine the actual problem in itself. Apart from TMJ (temporomandibular joint) disorders, the causes for orofacial pain can be systemic, neuropathic or neurovascular in nature as well.

The symptoms for orofacial pain can overlap, and sometimes the pain felt does not correlate with where the actual problem lies. For example, a patient may be having Facial Migraine, but experience pain in the teeth instead. Comorbidities such as osteoarthritis can complicate the process of getting a proper diagnosis as well.

On top of that, there are many different kinds of disorders within each category of orofacial pain. There are over 30 different types of disorders just within the category of TMJ-related orofacial pain alone.

*Disclaimer: Any reference to the terms ‘Orofacial Pain, ‘Oral Medicine’ and ‘Fellowship(s)’ are made within the context of the USA and not Singapore. Please refer to our Disclaimers and FAQ pages for more information.

As stated on the AAOP’s (American Academy of Orofacial Pain) website:

“Orofacial Pain is the specialty of dentistry that encompasses the diagnosis, management and treatment of pain disorders of the jaw, mouth, face, head and neck.”

A general overview

Who Gets Orofacial Pain?

Epidemiologic data on orofacial pain is not well documented due to the complexity and variations. It can range anywhere between 10 to 50 percent of the adult population, depending on the study.

According to Benoliel, R. et al. (2009), the prevalence of orofacial pain is around 17 to 26 percent, out of which 7 to 11 percent is chronic.

Women are twice as likely to experience orofacial pain as compared to men, and 43 percent of patients report pain in five or more different areas (Kohlmann, T., 2002).

Children and young adults can also get orofacial pain, with the most common complaints being temporomandibular joint pain, headaches and neuropathic pain (Sangalli, L. et al., 2021).

When the root cause of the pain is not addressed

Common Orofacial Pain Treatment Problems We See at Our Clinic in Singapore (Often Related to TMJ Disorders)

Misdiagnosis, Undiagnosis & the Impact on the Patient

Patients who visit our clinic often tell us that they have already tried all sorts of treatments and spent a lot of money in numerous attempts to curb their orofacial pain. They often feel demoralised, as the pain is relentless, and their quality of life has been impacted to a large degree.

There exists a worrisome group of ‘neuromuscular’ dental practitioners who ‘treat’ patients for orofacial pain and TMD (Temporomandibular Joint Disorders), yet their methods are often outdated or not evidence-based.

As a result, many patients are misdiagnosed and undergo unnecessary, unsuitable and often costly procedures. Some procedures are irreversible or can cause permanent damage as well, such as root canals or jaw surgeries. Other patients remain undiagnosed, and are only managed through vague concepts of ‘neuromuscular dentistry’ that are not evidence-based.

These patients are often told that they have a Temporomandibular Joint Disorder, and that their pain stems from an unsatisfactory ‘bite’. Attempts are then made to ‘reconstruct’ their bites. One big problem with such orofacial pain ‘treatments’ is that malocclusion may not be a problem in and of itself, and that majority of TMD patients do not actually have malocclusion.

Some of these so-called orofacial pain treatment modalities can easily go up into the five-figure realm – yet the pain persists.

How it’s classified

The Different Types of Orofacial Pain

As per the International Classification of Orofacial Pain (ICOP) (Benoliel & Svensson et. al., 2020), there are seven main classifications of orofacial pain. Under each of these classifications are branches of many other orofacial pain disorders that vary in pain and severity. Distinction between acute and chronic pain is important as well, in order for proper pain management and treatment. A patient can also have comorbidities or more than one type of orofacial pain, which makes getting a diagnosis trickier.

1. Dental Pain

Dental pain is one of the most common complaints of orofacial pain, and includes diseases, injuries or dysfunctions that pertain to the tooth pulp, periodontium (supporting structure for the teeth), gums, oral mucosa, salivary glands or jaw bone tissue.

When it comes to orofacial pain, pain felt in the teeth may not necessarily indicate a toothache.

You can read one of our case studies on Facial Migraine which manifested as teeth pain here.

2. Myofascial Orofacial Pain

‘Myo’ refers to muscle, and ‘fascial’ to fascia (the connective tissue around muscles). Primary myofascial orofacial pain can be acute or chronic in nature, whilst secondary myofascial pain is often attributed to other disorders such as tendonitis or muscle spasms.

Myofascial orofacial pain can be tricky to diagnose, as the pain felt is often not where the actual problem is coming from.

For example, we had a patient who experienced a toothache, but was actually suffering from a TMJ disorder. The pain in her jaw muscles were actually mimicking a toothache.

3. Temporomandibular Joint (TMJ) Pain

TMJ Disorders can also be acute or chronic, and sub-classified as primary or secondary. The pain may be intermittent or persistent, and varies in intensity. Apart from jaw pain, the patient may also experience pain in the orofacial region such as in their ears, neck and head. They may hear clicking sounds when they open their jaws (but not always). Or they may have difficulty moving their lower jaw.

In primary TMJ disorders, pain is localised to the temporomandibular joint, and can occur even when the jaw is at a resting position. Secondary TMJ pain can sometimes be attributed to arthritis, degenerative joint diseases, subluxation (partial dislocation) or disc displacements.

Jaw dislocation (“Open Lock”) is considerably rarer than TMJ locked jaw (“Closed Lock”), both of which we have diagnosed and treated at our clinic.

You can read the following case studies and visit our TMJ Disorder Treatment page for more information:

4. Orofacial Pain Attributed To Lesion Or Disease Of The Cranial Nerves

Orofacial pain under this classification can be attributed to dysfunctions or diseases with the trigeminal or glossopharyngeal nerve.

The glossopharyngeal nerve is the 9th cranial nerve and carries sensory, motor and parasympathetic information to our brains, and is involved in movement within the orofacial and throat region (Thomas, K. & Minutello, K., 2019). Glossopharyngeal Neuralgia can be Classical, Secondary or Idiopathic.

The trigeminal nerve is the 5th and largest cranial nerve that transmits sensory information via touch, pain and temperature to our brains, and is needed for jaw movement (Huff, T. et al., 2018). Dysfunctions with the trigeminal nerve can result in orofacial pain disorders such as cluster headaches and Trigeminal Neuralgia, which is one of the most painful chronic conditions one can experience. Trigeminal Neuralgia can also occur together with Glossopharyngeal Neuralgia.

Trigeminal Neuralgia can be tricky to diagnose as it can mimic many other orofacial pain disorders, and may be ‘invisible’ even on medical scans.

There are three different types of Trigeminal Neuralgia, which we have seen and treated at our clinic as well. Learn more about them here:

5. Orofacial Pains Resembling Presentations Of Primary Headaches

Orofacial pain can present as facial migraine and other types of head pain, and can occur on one or both sides of the head. It may be of an episodic or persistent nature, and is classified into Type 1, Type 2 and Type 3, depending on how and where the pain occurs.

Orofacial migraine can be difficult to diagnose because the patient may be feeling pain within the orofacial region, yet does not experience any head pain. The pain can also manifest as toothaches, which can mislead them into thinking that there is a problem with their teeth when that is not the case.

You can read the following relevant case studies of patients whom we treated at our clinic:

6. Idiopathic Orofacial Pain

Idiopathic means that the cause of the orofacial pain is unknown. It is often a diagnosis of exclusion, where other medical factors and causes are ruled out before a conclusion is reached. It is important to consult a trained Orofacial Pain specialist who is knowledgeable of potential causes and familiar with a myriad of health conditions, in order to work towards a proper diagnosis.

Idiopathic orofacial pain can occur on one or both sides of the face, tends to be persistent, moderate in intensity, and poorly localised (meaning that there is no specific area of pain where the patient can truly pinpoint it to).

It can present as Burning Mouth Syndrome (BMS), Persistent Idiopathic Facial Pain (PIFP), or Persistent Idiopathic Dentoalveolar Pain, all of which can be further defined as with or without somatosensory (sensation and localisation) changes.

You can read the following articles for more information:

7. Psychosocial Assessment Of Patients With Orofacial Pain

Whilst this category is not about specific disorders in and of themselves, it is still an essential component for the diagnosis and management of orofacial pain. It incorporates the biopsychosocial model, which takes into account biological, psychological and social factors that may be related to the patient’s pain experience. There is abundant evidence to indicate that health and disease are best understood within a biopsychosocial model, because these factors interact dynamically over time (Sharma, S. et al., 2020).

Assessment is made on the patient’s pain intensity, the impact on function and quality of life, and analysis of overuse behaviours in relation to the oral region (such as teeth clenching). This process helps to construct a clearer picture of the problem, especially when no physical evidence can be found as to the cause of the pain.

Orofacial Pain Treatment - How We Work with You at Nourish Dental & TMJ Care, Singapore

As you can see from these seven classifications, diagnosis and orofacial pain treatment is complex and can be tricky to pinpoint. Dr. Chionh of Nourish Dental & TMJ Care has encountered all classifications of orofacial pain in his practice over the years.

To begin, we do a thorough assessment of our patients’ medical history, lifestyle and concerns at our clinic, so as to understand them and their pain better. We believe that patient knowledge is crucial in the diagnosis process, as the patient knows their pain best.

Dr. Chionh also takes the time to answer any questions his patients may have about their orofacial pain. Combined with physical examination and investigations using the appropriate technologies, we can then derive a proper diagnosis, and come up with a suitable orofacial pain treatment plan for each of our patients.

Manage & treat your orofacial pain

Seeking Help from an Orofacial Pain Specialist

How an Orofacial Pain Specialist Can Help

Orofacial Pain is evidence-based, and is the 12th ADA (American Dental Associate) recognised dental speciality, which includes the diagnosis, management and treatment of pain disorders of the jaw, mouth, face, head and neck.

In order to earn their accreditation as an Orofacial Pain Specialist, a dentist needs to demonstrate a clear understanding of orofacial pain through graduate or postgraduate training, research or clinical experience. They also have to either:

be a Fellow of the American Academy of Orofacial Pain (AAOP), or
complete a formal advanced training education in Orofacial Pain that is accredited by the Commission on Dental Accreditation (CODA), or
has passed the American Board of Orofacial Pain (ABOP) Certification Examination.

The additional training grants insight and knowledge into pharmacology, oral medicine, and other orofacial pain treatment options that are not typically used in general dentistry.

Orofacial Pain Treatment Options

Pain management and treatment options for orofacial pain can vary widely, due to the complexity, comorbidities and overlap of symptoms. What works for one patient may not work for another, either.

Depending on the root cause, symptoms, pain severity and other variable factors, orofacial pain treatment options may include:

Physical therapy
Pharmacotherapy
TMJ injections
Oral appliances
Surgery
And more

As mentioned above, a biopsychosocial model for orofacial pain management is best approached as well. It is important to work with your orofacial pain specialist and/or healthcare providers as a team. Your pain experience is crucial information in helping them to not only derive a proper diagnosis, but also select the most suitable pain treatment plans for you.

Orofacial Pain from TMJ Disorders

In regards to TMD – which is a common cause of orofacial pain – there is no clear evidence that occlusal adjustments are useful in preventing or treating them (Romero-Reyes, M. & Uyanik, J. M., 2014).

The factors for TMD are also often multidimensional, and can include: biomechanical, neuromuscular, bio-psychosocial and biological factors (Chisnoiu, A. M. et al., 2015).

Generally, the most conservative treatment methods should be attempted first, as such adjustments are irreversible, and may cause more harm than good.

Read this post to learn more about what to watch out for, when it comes to orofacial pain treatment in relation to TMD.

Our focus at Nourish Dental & TMJ Care, Singapore

How We Can Help with Orofacial Pain Treatment

Dr. Eric Chionh Chye Kiat runs the practice at Nourish Dental & TMJ Care in Singapore, together with a dedicated team. He is not only a Fellow of the American Academy of Orofacial Pain (AAOP), but also an Academic Fellow of the American Academy of Oral Medicine (AAOM). He also holds a Singapore Dental Council approved qualification in these areas.

Dr. Chionh has over 20 years of hands-on experience in orofacial pain treatment and TMD, and is passionate about keeping himself updated on the latest scientific and dental literature. He aims to improve his patients’ quality of life using evidence-based medicine.

Our clinic uses the necessary technologies to diagnose, treat and manage each patient on an individual basis. We believe in working together with our patients as a team, in order to find the most suitable solutions to managing and treating their orofacial pain.

You can learn more about Dr. Eric Chionh on our About page, and view all services provided by Nourish Dental & TMJ Care here.

For more information or other pain and sleep dentistry treatments, visit these pages:
TMJ Disorder Treatment
Sleep Apnoea Treatment
Pain & Sleep Dentistry

Common questions & answers

Orafacial Pain Treatment FAQs

How is an Orofacial Pain Specialist Different from a General Dentist?

One of the key differences between the general dentist and orofacial pain specialist is in the area of education and training.

An orofacial pain (OFP) specialist needs to undergo additional training to expand their scope of knowledge beyond general dentistry. Such formal clinical training is also known as ‘residencies’ in the USA, and comprises many stringent examinations before one can gain their accreditation and practise orofacial pain treatment in clinic.

With the added insight into pharmacology and oral medicine, qualified orofacial pain specialists are familiar with dental and orofacial pain disorders, as well as medications that are not typically used in general dentistry. They are able to recognise, diagnose, manage and treat a range of orofacial pain disorders that include: neuropathic pain, masticatory, cervical pain, musculoskeletal pain, neurovascular pain, psychological concerns, sleep disorders and more.

It is important for general dentists to be able to recognise the signs and symptoms of orofacial pain as well, so that they can refer their patients to an orofacial pain specialist for further orofacial pain treatment and management.

What is the Most Common Cause of Orofacial Pain?

The most ‘common’ causes of orofacial pain include: migraine disorders, temporomandibular joint disorders, trigeminal nerve injuries, Burning Mouth Syndrome, and persistent dental and/or neuropathic pain.

As you can see, these are highly generalised causes. A trained orofacial pain specialist should be consulted, as they can help you figure out the exact cause of your pain, and also come up with an orofacial pain treatment and management plan that’s suitable for you.

For more information, read:

Does Orofacial Pain Go Away on Its Own?

Orofacial pain can be acute or chronic in nature. Acute orofacial pain is typically of a nociceptive (nervous system related) or inflammatory cause, and usually does not last for more than 3 months if the proper treatment is rendered.

Chronic orofacial pain lasts for more than 3 months and does not go away. However, there are pain management strategies that can be implemented, depending on the cause of the problem. It may also go into remission, where the pain is less severe or does not cause a problem for a period of time.

For more information on how Nourish TMJ Care can help, visit the following pages:

Which Body Parts Does Orofacial Pain Affect?

Orofacial Pain covers pain disorders of the jaw, mouth, face, head and neck. Pain in any of these areas, however, can stem from different anatomical sources. It could be a problem with the bones or joints, muscles, nerves, muscular system, salivary glands and more.

To complicate matters, secondary orofacial pain is often due to other health conditions, such as autoimmune diseases that include: Multiple Sclerosis, Lupus (SLE), Sjögren’s and Fibromyalgia. It could also be due to inflammation, viral or bacterial infections, or even occur after dental procedures.

One should consult a trained Orofacial Pain specialist for a proper assessment and diagnosis. This will help with the selection of a suitable orofacial pain treatment plan for you.

Why Can’t I Find a Diagnosis That Explains My Orofacial Pain?

Orofacial pain is often of a multifaceted nature, which would require a multidisciplinary approach, where you need to work with a team of healthcare professionals to manage the pain. It can also be idiopathic in nature, meaning that the cause is unknown.

Orofacial pain is often attributed to or diagnosed as dental pain or toothaches, when in fact, there is nothing wrong with the teeth or gums. According to the American Academy of Oral Medicine:

“Atypical odontalgia, also known as atypical facial pain, phantom tooth pain, or neuropathic orofacial pain, is characterized by chronic pain in a tooth or teeth, or in a site where teeth have been extracted or following endodontic treatment, without an identifiable cause. Over time, the pain may spread to involve wider areas of the face or jaws.”

In many cases of Atypical Odontalgia, dental treatment does not help to alleviate the pain, as there is nothing pathologically wrong with the teeth or gums, and the problem stems from elsewhere.

Can Other Disorders be Mistaken for Orofacial Pain?

Some other health conditions such as autoimmune diseases, sores, cancers and dry mouth can mimic orofacial pain, or rather, present as pain in the orofacial region. You can read more about some of these conditions on the American Academy of Oral Medicine’s website.

What is most important to differentiate is the root cause of the pain. Patients often experience or mistake their orofacial pain for toothaches, yet often their teeth are not the primary cause of their pain.

Orofacial Pain Disorders could be due to:

What is TMD/TMJ?

People often get confused between TMD and TMJ. ‘TMJ’ stands for temporomandibular joint, which are the jaw joints on each side of the jaw that connects to the skill. Without the TMJ, we will not be able to open our mouths, chew or talk.

‘TMD’ stands for Temporomandibular Joint Disorders, or TMJ Disorders. It is an umbrella term for over 30 different types of TMJ Disorders that affect the jaw, bite, head, facial and neck muscles, either by cause or effect. This can further lead to orofacial pain and/or loss of function and mobility in the orofacial region.

Why Choose Nourish Dental & TMJ Care?

Dr. Erich Chionh Chye Kiat helms Nourish Dental & TMJ Care, and takes a special interest in TMD, sleep dentistry, oral medicine, pain management, and orofacial pain treatment.

His approach is objective, analytical and evidence-based. He also takes the time to listen, explain and discuss questions and treatment options with all of his patients. He believes that knowledge is empowerment, and that it helps patients to feel more confident about managing their pain conditions.

Dr. Chionh is formally trained in Oral Medicine and Orofacial Pain, and holds a Singapore Dental Council approved qualification in these areas. He keeps himself updated on the latest scientific and medical literature on orofacial pain and related problems, so as to serve his patients to the best of his abilities.

You can find Dr. Chionh’s full list of credentials on our About page, and read more about Nourish Dental & TMJ Care on our blog.

Real patients we have seen at our clinic in Singapore

View Our Case Studies for Orofacial Pain Treatment

Why Your Toothache Might be Myofascial Pain (and Nothing to Do with Your Teeth) (Case Study #1)

Teeth Have Headaches, Too! (Case Study #2)

Excruciating Jaw Pain, Neck Pain & Headaches: Solving the Mystery (Case Study #3)

Sinus Toothache: When You Mistakenly Treat the Teeth Instead (Case Study #4)

Trigeminal Neuralgia: The Great Toothache Mimicry (Case Study #5)

Burning Mouth Syndrome: A Mouthful of Burning Issues (Case Study #6)

A Rare Case of Pemphigus: Sudden Onset of Blisters in the Mouth (Case Study #7)

TMJ Locked Jaw Treatment (A Frightening Experience of a ‘Closed Lock’) (Case Study #8)

When Idiopathic Trigeminal Neuralgia is Mistaken for Something Else (Case Study #9)

Testimonials and reviews

What Our Clients Say

"Dr Eric , the tmj specialist, is very thorough in his examination, diagnosis and treatment plan.His sincerity and genuine concern for his patients is very evident. He exhibits so much professionalism too. If you have a tmj pain,go to his clinic. I have been to 2 other dentists before for the tmj issue and one was very skimpy and brushed aside many things."

"Nourish Dental Care & Implant provides a nice and comfortable atmosphere, especially the waterfall feature at the reception area definitely helps to soothes the nerves and anxiety.

Dr Chionh is a very gentle and caring dentist. He made sure that I understood exactly what is going on with my teeth and gums, and provided clear communication throughout the procedure. He took time to answer every question / concern and is genuine in his recommendations.

He is also skillful and passionate, and I appreciate his occasional jokes to liven up the mood.

The dental assistant is friendly and efficient. She makes me feel welcome and is always helpful when I need to make changes to my appointments.

The services provided are reasonably priced. I’d highly recommend Dr Chionh and his clinic."

"I went to Dr Eric because of my TMJ condition and I am pleased to say that I am now managing my condition so much better. Dr Eric's patience, care, careful assessment of my condition and holistic treatment plan did marvels for me. Even the implant I did thereafter was painless. I am impressed by Dr Eric's skillful execution of each step which was carefully deliberated and calibrated. I have confidence in Dr Eric's ability. He takes every effort to solve problems."

"I was suffering from a whole array of headache, head & neck pain issues and went from doctor to doctor. I visited ENTs, Medical & Dental GPs, as well as Sports Medicine Practitioners & Chiropractors. At Nour!sh, I finally got my diagnosis - Fibromyalgia.

I am coping much better now, thanks to the excellent management of my condition by the team @ nour!sh. Thank you very much. I finally got my life, lost to pain, back!"

"Dr. Chionh was very professional and explained in great details. Joe Ling was very caring and took extra care of me during the procedure. Appreciate it and hope all is well."

"Excellent consult. Very clearly explained."

"I needed a crown on my Molar with both gum surgery and session forming tooth for crown fitting. Procedures were completed with upmost professionalism by Dr Chionh. I felt very safe in his hands and whilst a tough procedure to go through he made me feel in total control. I would highly recommend him and Nourish to my friends."

"Dr Eric provides a comprehensive dental services and high quality of a professional dentist. Certainly a peace of mind when visit him."

"Brought my 60+ year old mum for implant surgeries. Had 2 done without much pain and discomfort. My mum did not even take any painkillers after. Amazingly good."

"Dr Chionh is always very professional, caring and assuring. I have been to many dentists before and I haven't met anyone so thorough and informative like him. He will make you feel comfortable and his staff are friendly and approachable too. I highly recommend this dental clinic!"

"Thanks for the treatment. The mouthguard was not what I expected - it fits really nicely and helps to cushion and soften the teeth grinding.

Do help me thank Dr. Eric; if not for him, I would still be dealing with migraine, which has been plaguing me for the past few months."

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