Orofacial Muscle Pain

Orofacial pain is one of the most unique and controversial topics in the field of dentistry. This is because most of the times, orofacial muscle pain is categorized under temporomandibular joint disorder. However, it is essential to understand that orofacial pain has distinct characteristics as compared to temporomandibular joint disorder.

Orofacial muscle pain is typically described as a unilateral pain in the temporomandibular region of the face. The pain aggravates by oral functions and movement of the regional muscles. Most of the times, orofacial pain occurs persistently until treated. Patients who suffer from orofacial muscle pain undergo a long term medical and physiological therapy.

Several causes can lead to orofacial muscle pain like neural stimulation, masticatory problems, temporomandibular joint problems, cervical muscle pain, stress, and depression. Treatment of orofacial muscle pain often depends on the cause. However, most of the times, it is done by a symptomatic approach.

Today’s article will summarize the common types of causes that lead to the development of orofacial muscle pain. Furthermore, we will discuss the symptoms and pain management techniques.

What is orofacial muscle pain?

Orofacial muscle pain is a broad term which is usually used to describe the symptoms associated with dysfunction of the head and neck muscles. But because of its close co-relation with temporomandibular joint dysfunction, orofacial muscle pain is often misinterpreted as one of the symptoms of TMJ disorders. (1)

The characteristics of orofacial muscle pain can differ depending on the source of origin. However, most of the times, the symptoms develop gradually and usually originate from neurovascular, neuropathic, or musculoskeletal dysfunctions in the head and neck region.

Often patients with orofacial muscle pain feel a tingling sensation, ringing in the ear and itching at the affected area. Orofacial muscle pain is one of the significant factors that cause temporomandibular discomfort. (2) Women are more prone to develop orofacial muscle pain as compared to male, and the first symptoms usually occur during the early 20s or around the time of menopause.

What causes orofacial muscle pain?

As mentioned above, orofacial muscle pain comprises of a group of disorders that may affect the muscles of the face and mouth. Several causes of orofacial muscle pain may range from infection to nerve damage. Following is a list of potential causes of orofacial muscle pain –

  • An oral disease that mainly involves the salivary gland and duct
  • Sinusitis
  • Temporomandibular joint disorder
  • Jaw pain
  • Open sore or ulcers around the mouth
  • Untreated tooth abscess that has increased to cause facial swelling (3)
  • Skin abscess formed as a result of an infection on the face
  • Migraine or tension headache affecting surrounding nerves
  • A traumatic facial injury that causes nerve damage
  • Wisdom tooth extraction associated with dry socket
  • Deviated nasal septum
  • Sleep disorders
  • Bruxism or teeth grinding

In addition to the common causes mentioned above, some of the severe causes of orofacial muscle pain include infectious lesions like herpes zoster, mumps, and sinusitis. Oral cancer is another potential cause of orofacial muscle pain. (4) Some of the health conditions that may cause orofacial muscle pain include –

  • Multiple sclerosis – a disabling disease that leads to disrupt the flow of neural transmission in the brain causing muscle incoordination
  • Fibromyalgia – a condition characterized by chronic pain in the muscle and tissues around the joints in the face and body.
  • Hypoparathyroidism – a hormonal fluctuation in the parathyroid gland that decreases the flow of parathyroid hormone.
  • Polymyalgia rheumatica – an inflammatory condition of the muscles that often leads to stiffness and pain.
  • Extensive surgical removal of a tumor from the mouth or face that may restrict the muscular functions of the face.
  • Trigeminal neuralgia – a unilateral sharp shooting pain which is often associated with multiple trigger points on the face. It is mainly caused due to irritation or inflammation of the trigeminal nerve that serves several parts of the face and mouth. (5)

What are the signs and symptoms of orofacial muscle pain?

Symptoms of orofacial muscle pain typically start as a cramp-like pain. The characteristics of the pain may vary from dull and throbbing to a severe sharp and stabbing type of pain. Other common signs and symptoms of orofacial pain include –

  • Difficulty in opening the mouth
  • Difficulty in chewing, swallowing or speaking
  • Extreme discomfort in the face, lips, gums or cheeks
  • Unilateral pain around the mouth or near the temporomandibular joint
  • Presence of dental abscess or extensive cavity
  • Pain that is commonly associated with sinusitis can feel like a constant pressure or ache across the face, cheekbones or near the eyes (6)
  • Soreness of the masticatory muscles
  • Associated headache
  • Muscle spasm or sudden contractions on the face and around the mouth

The pain associated with orofacial muscle dysfunction can be continuous or intermittent. Sometimes the patient may also experience dizziness as a result of excessive neural stimulation.

How is orofacial muscle pain diagnosed?

Typically, the diagnosis of orofacial muscle pain begins by taking a complete medical and dental history of the patient to rule out the presence of any current health conditions. A thorough dental examination is performed to review the symptoms and check for clinical signs of abscess, infection, injury, or cancerous lesions. While determining the severity of the pain, the dentist may ask about the location, frequency, character, type, and duration of the pain. Furthermore, it is best to always tell the dentist upfront about any other associated symptoms.

Often orofacial muscle pain is associated with temporomandibular joint disorders. To rule out this condition, the dentist may ask the patient to perform multiple jaw movements and functions. This is done to check the range of jaw movements. Examination of the head and neck can reveal the presence of swollen lymph nodes that may indicate an underlying infection. Additional tests are performed to confirm the source of orofacial muscle pain. Some of the confirmatory tests include –

  • ECG to rule out heart conditions
  • Radiographic interpretation of the sinuses accompanied by a set of dental x-rays to check the extension of tooth infections if present. Additionally, panoramic dental x-rays can give a full view of the dental condition along with the conditions related to the temporomandibular joint.
  • Neurological tests to check for nerve damage
  • Blood tests to rule out infectious diseases

Once the diagnosis is confirmed, the patient may be provided with appropriate dental treatment or referred to a medical professional to treat the underlying health conditions. It is essential to understand the importance of proper medical care. Prompt treatment of orofacial muscle pain can take you a long way in living a comfortable pain-free life.

What are the different treatments for orofacial muscle pain?

Usually, the first step towards treating orofacial muscle pain is to relieve the painful symptoms. Symptomatic treatment of orofacial muscle pain includes the use of mild analgesics. A further treatment plan is made based on the type of cause. Some of the treatment options for orofacial muscle pain are listed below –

  • A nerve block generally treats neuropathic pain. The nerve block is a type of anesthetic technique which controls pain perception at the area of origin. Usually, it is given by a dental professional.

Neuropathic pain is typically treated by using nerve block managed by electrical stimulation which blocks all the sensory pain perceptions in the nerves that innervate the affected muscle. Additionally, the dentist may also prescribe anti-inflammatory and anticonvulsant medications to comfort the patient.

  • Orofacial muscle pain caused by sinusitis is usually treated with antibiotic coverage. The infections subside on its own when the antibiotics are started. However, in severe cases of sinusitis, drainage may be necessary to relieve the pain and disease.
  • Often migraine or tension headaches are treated with over-the-counter pain medications or prescription-based pain relievers.
  • Orofacial muscle pain caused by a dental infection such as tooth abscess, extensive tooth decay, or dry socket is treated by a dental professional. The treatments may range from root canal therapy to tooth extraction. Antibiotic coverage is provided in such cases as well.
  • People with a habit of teeth grinding or bruxism are advised to wear a protective mouthguard or plastic splint. This device prevents the teeth from contacting one another and prevents the damage caused by the grinding motion. Mouthguards are custom fabricated by a dental professional.
  • Treatment for sleep disorders includes use of anxiolytics before sleeping. Generally, low dose benzodiazepine effectively manages acute pain symptoms. However, care should be taken in patients who suffer from sleep apnea as anxiolytics can aggravate the symptoms in such situations.

For such patients, mild analgesics like acetaminophen and NSAIDS work well individually or in combination.

  • Physiotherapy plays a crucial role in managing the orofacial muscle pain. Some physical modalities like TENS – transcutaneous electric nerve stimulation can be used to treat jaw-related problems.

Another modality is ‘spray and stretch’ – in this the skin of the affected area is numbed using an ice pack or a skin refrigerant spray, for example, ethyl chloride. After this, the patient is asked to stretch the jaw as much as possible. Recently botulinum toxin has proved to be a great muscle relaxant and is used in severe cases of orofacial muscle pain.

How can you manage the symptoms of orofacial muscle pain at home?

Most of the people prefer to manage their painful symptoms by following home remedies that can effectively relieve orofacial muscle pain. However, it is essential to know that such techniques are only good for temporary pain relief. Sometimes, the symptoms can aggravate due to lack of proper treatment. (7)

One of the most common home remedies for relieving orofacial muscle pain is to use over-the-counter pain medications such as acetaminophen and ibuprofen. If you are unsure about the type of drugs that can help you provide temporary pain relief, consult a doctor or a dental professional for recommendations. Other typical at-home pains relieving techniques include –

  • Hot and cold compress – warm compress can be easily made at home by dipping a clean cloth in hot water. Squeeze the excess water from the cloth and gently apply pressure on the affected skin.

Cold compresses are usually preferred in case of swelling or tooth abscess. However, you can use cold compress depending on your suitability. To make a cold compress wrap an ice pack in a clean cloth and apply intermittent gentle pressure on the affected skin for several minutes.

  • Often orofacial pain caused by dental problems can aggravate the symptoms on chewing hard food. Therefore, when in pain, switch to a healthy soft diet.
  • Try to avoid talking too much
  • Avoid yawning or any other type of jaw movements as it may lead to locking of the jaw
  • One of the causes of orofacial muscle pain is stress and anxiety. Stress and anxiety can have many other harmful effects on mental health and the overall health of the body. Moreover, it is one of the prime triggers of migraine and tension headache. It is essential to try relaxation therapies or stress reduction exercises like deep breathing, meditation, and yoga.

Overview of orofacial muscle pain

Chronic orofacial muscle pain is a group of conditions that usually target the muscles of the face and causes extreme or unbearable pain stimulation. Most of the times the orofacial pain initiates as a result of neuropathic stimulation of the facial muscles, masticatory dysfunction or temporomandibular joint disorder. Stress and anxiety is also a significant contributor for orofacial muscle pain.

Most of the people try to manage the symptoms of orofacial pain by testing some home remedies for pain relief. However, it is essential to immediately consult the dentist or a medical professional to address the condition and diagnose the appropriate cause. Early diagnosis helps to seize the symptoms quickly and improve the quality of patient’s life.

Usually, asymptomatic therapeutic approach is used at the beginning stages. The treatment can be modified as the cause of the condition is identified. If you are suffering from any of the symptoms mentioned above, talk to your dentist and get your condition checked immediately to live a healthy life.