Chronic orofacial pain is a symptom associated with a
wide range of neuropathic, neurovascular, idiopathic, and myofascial conditions
that affect a significant proportion of the population. While the collectiveimpact of the subset of the orofacial pain disorders involving neurogenic and
idiopathic mechanisms is substantial, some of these are relatively uncommon.
Hence, patients with these disorders can be vulnerable to misdiagnosis,
sometimes for years, increasing the symptom burden and delaying effective
treatment. This manuscript first reviews the decision tree to be followed in
diagnosing any neuropathic pain condition, as well as the levels of evidence
needed to make a diagnosis with each of several levels of confidence: definite,
probable, or possible.
It then examines the clinical literature related to the
idiopathic and neurogenic conditions that can occasion chronic orofacial pain,
including burning mouth syndrome, trigeminal neuralgia, glossopharyngeal neuralgia,
post-herpetic neuralgia, and atypical odontalgia. Temporomandibular disorders
also are examined, even though they are not neurologic conditions, because they
are common and can mimic symptoms of the latter disorders. For each of these
conditions, the paper reviews literature regarding incidence and prevalence,
physiologic and other contributing factors, diagnostic signs and symptoms, and
empirical evidence regarding treatments. Finally, in order to improve the
quality and accuracy of clinical diagnosis, as well as the efficiency with
which effective treatment is initiated and delivered, criteria are offered that
can be instrumental in making a differential diagnosis.(Read more)
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