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FACIAL PAIN: NEUROLOGICAL AND NON-NEUROLOGICAL
  1. Joanna M Zakrzewska
  1. Correspondence to:
 Dr Joanna M Zakrzewska, Department of Clinical and Diagnostic Oral Sciences, Oral Medicine Unit, Barts and the London Queen Mary’s School of Medicine and Dentistry, Turner Street, London E1 2AD, UK;
 J.M.Zakrzewska{at}.qmul.ac.uk

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The article will give the reader:

  • An overview of facial pain in terms of epidemiology, classification, diagnosis and management

  • Three case histories on which to try out diagnostic skills

  • An overview of management of three types of facial pain.

EPIDEMIOLOGY

Pain in the facial area may be due to neurological or vascular causes, but equally well may be dental in origin. The patient will often make the first attempt at diagnosis in that he or she chooses to consult either the dentist or the doctor. This may therefore lead to inappropriate diagnosis and treatment. Many patients with trigeminal neuralgia complain that their dentist treated them for dental causes of pain before finally they received the correct diagnosis. This is, however, highly understandable as dental pain is extremely common whereas trigeminal neuralgia is a rare condition and primary care medical and dental practitioners may only see three or four cases in their practising lifetime. All the neurological and vascular causes of facial pain (excluding headaches) are rare compared to the dental and temporomandibular causes. The risk factors for some of the conditions are known, but there is little information on natural history and prognosis. Further details of the epidemiology of facial pain can be found in Epidemiology of pain, which has been written using evidence based methodology.1

CLASSIFICATION AND DIAGNOSIS

A classification system is useful when attempting to make a diagnosis, to facilitate treatment decisions, and to predict future outcome. Not only does the pain itself need to be classified but also its psychosocial effects. The International Association for the Study of Pain (IASP)2 and the International Headache Society (IHS)3 have both classified these pains, and the fourth revision of the Diagnostic and statistical manual (DSM-IV) enables you to classify psychiatric disorders. Unfortunately only a handful of orofacial conditions have been …

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