OROFACIAL NEURALGIA - DIAGNOSIS AND TREATMENT GUIDELINES

Patients with facial pain, without Overt dental disease, are often see n in both medical and dental practice. The differential diagnosis incl udes (a) cluster headache, in which patients have severe unilateral pa ins lasting 30 to 120 minutes that respond to verapamil, corticosteroi ds or lithium; (b) migraine, in which attacks are longer and are often accompanied by nausea and visual disturbance, and can be managed usin g anti-inflammatory analgesics, with or without metoclopramide, or sum atriptan, although frequent attacks are best suppressed by continuous propranolol or pizotifen; (c) trigeminal neuralgia, knifelike unilater al pains usually responsive to carbamazepine; and (d) temporal arterit is, a steadier pain very responsive to corticosteroids. There is no ev idence that continuous 'idiopathic facial pain' is a result of maloccl usion (i.e. the way in which the teeth fit together), and its aetiolog y remains obscure, although there is some biochemical evidence linking it to depression. Many patients respond to simple analgesia and firm reassurance from the physician, although antidepressant therapy (e.g. nortriptyline or dothiepin) is often of great value.