Zeroing in on the cause of your patient&#039;s facial pain

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Applied Evidence

Zeroing in on the cause of your patient's facial pain

J Fam Pract. 2015 September;64(9):524-526,528-531B

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References

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The most common signs and symptoms of giant cell arteritis are temporal headache, jaw claudication and tenderness, and swelling of the temporal artery.

Malignancy is a rare cause of facial pain. The pain may be due to metastasis of extracranial bony or soft tissue as it compresses cervical and cranial nerves.³ Lung cancer can cause referred pain in the periauricular region by compressing the vagus nerve, and this pain can be misdiagnosed as dental pain, atypical facial pain, TMD, or TN.^3,29 The facial pain of lung cancer is unilateral and on the same side as the lung neoplasm, and commonly is referred to the jaw, ear, or temporal region. While many patients have continuous pain, some report intermittent pain or pain that lasts for hours.³ Facial pain caused by a malignancy is differentiated from other sources of facial pain by the presence of associated symptoms such as weight loss, cough, and hemoptysis.

Treatment. Treatment can include radiation or chemotherapy.²⁹

The mouth is often the source of lower facial pain

Pain in the oral cavity is the most common cause of pain in the lower face.¹⁵ Intraoral pain usually is caused by disease in the following structures:
1. Dentition (eg, caries, dentin sensitivity, pulpal disease)
2. Periodontium (eg, gingivitis, acute or chronic periodontal disease, sensitivity related to gum recession, alveolar bone pathology)
3. Other soft and hard tissues, such as the palate, floor of mouth, buccal mucosa, non-tooth supporting bone, and tongue (eg, mucosal diseases, neoplasms, pain related to parafunction or trauma).

Rarely, intraoral pain may be referred. For example, myofascial pain might cause diffuse tooth pain.³⁰

See TABLE W1^31-35 at the end of this article for a summary of the etiology, signs/symptoms, diagnosis, and management of these and other dental causes of oral facial pain.

Nondental causes of oral facial pain can be associated with oral mucosal disorders, malignant disease and its therapy, salivary gland disorders, maxillary sinusitis, burning mouth syndrome, or atypical odontalgia. See TABLE W2^36-41 for a more detailed description of these conditions.

CORRESPONDENCE
Tamer H. Said, MD, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, Ohio 44109; tsaid@metrohealth.org