Differential Diagnostics of Painful Conditions of Oral Mucosa

Orofacial pain is a common complaint and challenging diagnostic problem. Among numerous causes of orofacial pain, the most common are diseases of teeth and periodontium, followed by various diseases and lesions of the oral mucosa. Pain of the oral mucosa is an accompanying symptom of different mucosal lesions caused by local or systematic factors. This type of pain belongs to the category of superfitial somatic pain, termed mucogingival pain. However, the pain of oral mucosa may be present in the absence of pathological findings. This type of pain may be caused by lesion of the nervous system, and is termed neuropathic pain, or it may be result of psychogenic disturbances. Pain of the oral mucosa can be also reflected (refered pain) from other parts of the body. Given the multitude of possible causes of intraoral pain as a component of orofacial pain, the diagnostic process is complex and requires a multidisciplinary approach. A prerequisite for establishing an accurate diagnosis is thorough knowledge of a wide spectrum of diagnostic characteristics of orofacial pain which include the origin and type of pain (somatic, neurogenic and psychogenic), duration (acute or chronic) and mechanisms of pain onset (nociceptive, neuropathic, psychosomatic) and their differentiation. The emphasis in this article is on differential diagnosis of the most common painful conditions of oral mucosa in respect to their clinical features.