Why are the diagnosis and management of orofacial pain so challenging?

Pain is the primary reason patients visit a physician or dentist, and the diagnosis and management of pain in the face, mouth and jaws have been integral components of dental practice since dentistry became a widely recognized profession in the 19th century. Epidemiologic studies reveal that a large proportion of the population in many countries currently suffers from temporomandibular disorders (TMD), toothaches, headaches and other conditions associated with orofacial pain.1,2 Indeed, some of the most common pain conditions in the body occur in the orofacial region and many of these are chronic (i.e., lasting more than 3 months). These chronic conditions range from such common problems as TMD and burning mouth to less-frequent disorders, such as trigeminal neuralgia and so-called atypical odontalgia. Most chronic pains represent a diagnostic or management challenge to dentists for several reasons, including the inadequate education most dentists receive regarding pain.