Core Curriculum for Professional Education in

Pain, edited by J. Edmond Charlton, IASP Press,

Seattle, 2005.

38
Orofacial Pain
I.

Anatomical, physiological, and psychological aspects of orofacial pain (Dubner et al. 1978; Dworkin and
LeResche 1992; Zarb et al. 1994; Fricton and Dubner 1995; Sessle et al. 1995; Sessle 2000; Lund et al.
2001; Svensson and Graven-Nielsen 2001). Have a broad general knowledge of the anatomy and
physiology of the orofacial structures, particularly of the peripheral nerve distribution of the major
trigeminal nerve trunks and other cranial nerves, the anatomical relations of the structures they innervate,
and their primary central connections.
A. Be able to recognize the commonalties between the trigeminal system and the spinal and lemniscal
systems that make current concepts of nociceptive transmission and its control applicable to the
trigeminal system.
B. Recognize the features that distinguish these systems, e.g., in the trigeminal system, the proportion of
myelinated to unmyelinated fibers and the properties of some of these fibers are different from those
in spinal nerves; the occurrence of sites (e.g., tooth pulp, cornea) in the orofacial region that are
predominantly or exclusively innervated by nociceptive afferents; the bilateral and disproportionately
large representation of the orofacial region in higher levels of the somatosensory system; the exquisite
sensibility of orofacial tissues.
C. Be familiar with psychological and psychosocial factors associated with orofacial pain and other pain
conditions.

II.

Diagnosis of orofacial pain (Attanasio and Mohl 1992; Dworkin and LeResche 1992; Zarb et al. 1994;
Fricton and Dubner 1995; Okeson 1995; Sessle et al. 1995; Sharav 1999; Zakrzewska and Harrison 2002;
Lund et al. 2001).
A. Have a broad general knowledge of the major diagnostic features and possible etiological,
epidemiological, and pathophysiological aspects of pain associated with:
1. Specific sites: tooth and surrounding structures, temporomandibular joint, muscle, mucosa, sinus,
bone, salivary glands
2. Orofacial pain conditions including neuralgias, neuropathic pain, painful temporomandibular
disorders, and neurovascular and other headaches.
B. Pain history and clinical examination.
1. Know the general principles of taking a structured orofacial pain history and carrying out a clinical
examination of the orofacial region and adjacent structures.
2. Be aware that there are objective and validated tests and procedures used for differential diagnosis
of many of the above but that some diagnostic approaches still lack reliability, validity, specificity,
or sensitivity. Tests and procedures include tooth pulp vitality and tooth percussion tests, muscle
palpation tests, salivary tests, quantitative sensory and neurophysiological tests, and other physical
exams; behavioral and psychosocial assessments; radiographs and other imaging techniques;
microbiological and serological tests; biopsies; and controlled nerve blocks.
3. Know the common orofacial patterns of pain referral. Be aware that orofacial pain may sometimes
be referred from remote sites (e.g., earache, cardiac pain, intracranial lesions).

Orofacial Pain

III.

Treatment of orofacial pain (Attanasio and Mohl 1992; Zarb et al. 1994; Fricton and Dubner 1995; Okeson
1995; Sessle et al. 1995; Sharav 1999; Zakrzewska 1999; Lund et al. 2001; Mohl et al. 2002).
A. Be informed of the current evidence-based management approaches, and their indications and contraindications, for the different types of orofacial pain noted in section II. Some of the commonly used
therapeutic approaches include pharmacological agents, surgery, physical medicine, and
multidisciplinary approaches, as well as the use of support groups. Be able to inform the patient on
these topics.

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