Idiopathic orofacial pain
Authors:
P. Řehulka 1; A. Bártková 2
Authors‘ workplace:
I. neurologická klinika, LF MU a FN u sv. Anny v Brně
1; Neurologická klinika, LF UP a FN v Olomouci
2
Published in:
Cesk Slov Neurol N 2025; 88(1): 39-46
Category:
Review Article
doi:
https://doi.org/10.48095/cccsnn202539
Overview
Idiopathic orofacial pain is a group of painful disorders affecting the facial region and/or oral cavity with unclear etiology. This group includes burning mouth syndrome, persistent idiopathic dentoalveolar pain, persistent idiopathic facial pain, and constant unilateral facial pain with additional attacks. These are acquired diseases of adulthood, most commonly affecting postmenopausal women. The etiology of these disorders is not entirely understood, but likely involves changes at both the peripheral and central levels of the somatosensory system, including small fiber neuropathy, subclinical peripheral neuropathy, alterations in brainstem functions, and changes in central inhibitory pain modulation. Although some patients mistakenly consider dental treatment as the triggering situation, a causal relationship with invasive procedures in the oral cavity has not been unequivocally proven. Diagnosis is based on evaluating the clinical characteristics of the pain and excluding secondary causes. Treatment strategies include acute topical application of certain medications or long-term off-label treatment (antidepressants, antiseizure medications). The effectiveness of pharmacological treatment may be limited, often due to side effects. Expert agreement is that early diagnosis and pharmacological therapy are positive prognostic factors, while repeated invasive procedures worsen the prognosis. Comorbid depressive and anxiety symptoms affect roughly one-third to one-half of patients. Psychosocial stress can exacerbate the disease course. Spontaneous improvement occurs in only a minority of patients (at most one-third), usually after two to seven years of disease duration. Providing sufficient information about the diagnosis and reassuring the patient about the neurobiological nature of the disease remains crucial. Supportive psychotherapeutic treatment is also recommended.
Keywords:
trigeminal neuralgia – facial pain – burning mouth syndrome – dentoalveolar pain
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Czech and Slovak Neurology and Neurosurgery
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