Orofacial Pain: An Introduction

Pain in your teeth or face may actually originate in other parts of the head—and a form of migraine may be the cause.

By Dr. Marcela Romero-Reyes 

People with persistent pain in their teeth or mouth often turn to their dentist for help. But what if the dentist doesn’t find a cause of the pain? Nothing shows up during your regular exam, and your x-ray looks normal. These suspicious “toothaches” may be due to referral pain from a muscle, or due to a nerve disorder, or even a headache disorder.

Dental pain is a type of orofacial pain and can often be treated by dental procedures. But orofacial pain can also be caused by nondental pain disorders that resemble pain in your teeth, mouth or face. The true origin of the pain, however, is elsewhere. Not all dentists and oral surgeons have advanced training in orofacial pain disorders. But those who do can help you get to the root of the problem.

Here’s a brief breakdown of orofacial pain. We’ll cover what it is, how you can help your doctor to diagnose it and how it could be connected to migraine. 

What is Orofacial Pain?

Orofacial pain is a field of dentistry. It deals with the diagnosis and care of nondental pain that presents in the head, face or neck, or inside your mouth. These types of disorders all have unique causes and treatments.

Orofacial pain is associated with a number of conditions. Some of the most common are musculoskeletal disorders like temporomandibular disorders (TMD). TMDs are disorders involving the temporomandibular joints (TMJs), which help control the jaw. They also affect the muscles used to chew and talk, as well as other associated structures. 

TMD is most prevalent in women, but overall, about 5 to 12% of people can have some form of TMD. A form of TMD, known as myofascial pain, presents “referred pain.” This is where pain is felt in a different part of the body than where it’s originating. For example, if your teeth hurt and your dentist did not find a dental cause for your pain, the pain may be “referred” from other muscles in your face or head.

Another facial pain disorder is trigeminal neuralgia. This is where brief, sharp, shooting, electrical and severe pain can be triggered by actions that don’t normally hurt. For example, lightly touching your face, brushing your teeth, talking, chewing or shaving can all trigger pain in trigeminal neuralgia. 

Burning mouth syndrome is another facial pain disorder. It involves a burning feeling inside your mouth and, commonly, in the tongue.

The Migraine Connection

Migraine can sometimes resemble pain in the facial area. This means that patients with migraine localized in the face may confuse it for dental or other orofacial pain. In addition, TMD and headache disorders commonly occur together, with migraine being the most common headache disorder for TMD patients. TMD symptoms can amplify migraine and may increase the likelihood of it becoming chronic. 

How to Help Your Doctor

Pain is a personal experience, so it can be very tricky to explain it. It is helpful for doctors to know where the pain is located, if it’s always there or comes and goes, how long it lasts, and any associated symptoms. 

It also helps to describe what your pain feels like. Descriptors like dull, aching, throbbing, pulsating, burning or tingling are great ways to explain your pain. For example, if you say, “I feel like I have electric shocks in my face,” that tells doctors it could be something nerve-related. It’s also helpful to know what you’re doing when it happens. If you tell your doctor it hurts when you open your mouth wide, or when you’re chewing or talking, this could suggest a possible TMD.

If you are living with orofacial pain, remember that you are not the only one. This is something that affects a number of people, and your doctor can help you find the right diagnosis and care. For help finding a healthcare professional who’s right for you, check out the American Migraine Foundation’s Find a Doctor tool

—Dr. Marcela Romero-Reyes is a clinical associate professor and clinical director of the Brotman Facial Pain Clinic at the University of Maryland School of Dentistry.