**4. Orofacial pain diagnosis**

The ability to understand and investigate the pathophysiologic processes underlying a disorder, depends on a valid, reliable classification system and common terminology to facilitate communication among clinicians, researchers, academicians, and patients.

A review of the literature regarding the classification of orofacial pain reveals a lot of classification systems with varying advantages and disadvantages [20–43]. Despite all these classifications, currently, the most accepted among the clinicians and researchers dedicated to orofacial pain is the Research and Diagnostic Criteria for temporomandibular disorders (RDC/TMD and DC/TMD).

The taxonomy of "Diagnostic criteria for temporomandibular disorders" (DC/ TMD) is an evolution of the original "Research diagnostic criteria for temporomandibular disorders" (RDC/TMD). It uses a dual-axis system in which, on Axis I, the physical diagnosis is based on pathophysiology and grading of chronic pain and on Axis II depression, anxiety, and non-specific physical systems are scored, in order to determine the distribution of subtypes of TMD, psychological disorders and psychosocial dysfunction [32, 33, 44, 45]. It is important to emphasize that with the advent of the RDC TMD, it was possible to describe and compare appropriate TMD subtypes and psychosocial profiles using clearly defined and validated diagnostic criteria in groups of TMD patients, and is used in different parts of the world [34, 35, 46, 47].

An accurate orofacial pain diagnosis is obviously the first step to achieve the correct treatment for the patient. This means that the clinician must be aware of both the Axis I and Axis II of the DC/TMD. The diagnostic process involves defining the inclusion criteria that are specific to a disorder as well as ruling out specific disorders that can cause similar symptoms.

Establishing the correct diagnosis in orofacial pain is particularly difficult because of the complex inter-relationship of physical and psychological factors in the etiology of biopsychosocial chronic pain syndromes. Thus, the differential diagnosis is a critical process that—if failed—can often lead to an inappropriate treatment.

The broad categories included in the new guidelines for Assessment, Diagnosis, and Management of Orofacial Pain are as follows [36, 48]:

**91**

*Sleep and Orofacial Pain: Physiological Interactions and Clinical Management*

• Extracranial and systemic causes of orofacial pain.

**4.1 Vascular and nonvascular intracranial pain disorders**

In this group, the differential diagnosis is essential since disorders like aneurysm, hemorrhage or hematoma, neoplasm, and edema can be life threatening and may require immediate care. The signs and symptoms include new or abrupt onset of pain, severe pain, and interruption of sleep by pain. In addition, non-pain symptoms may occur. Weight loss, ataxia, weakness, fever, changes in the neurologic examination, and neurologic deficits are common

Migraine and tension-type headache (TTH) are considered the most prevalent among primary headaches. TTH affects 60–80% of the population while migraine has a prevalence of 15% (male 7.6%, female 18.3%) [39, 51]. Cluster headache is not very common (0.1%) [40, 41, 52, 53]; however, it is often misdiagnosed and mismanaged [42, 54]. Despite be a secondary headache disorder medication-overuse headache (MOH), it often co-exists with primary headache disorders, and conse-

Dental and other oral diseases are very prevalent conditions in the general population. Pain complaints are the primary reason why most patients seek care from dental or medical doctors. Thus, regardless of intraoral pain is not exclusively a result of dental disorders, it is essential that all complaints of pain in the mouth and face are carefully studied in order to know if there is a dental problem in its origin. There are a lot of common somatic intraoral pain disorders, which can originate from disease involving one or more broad anatomic areas: the teeth, the surrounding soft tissues (mucosa and gingiva, tongue, salivary

Neuropathic pain is defined as a symptom caused by a lesion or disease of the somatosensory system, including peripheral fibers (Aβ, Aδ, and C fibers) and central neurons. Its prevalence is about 7–10% among the general population. Different causes of neuropathic pain have been described. Undoubtedly, there is a connection between neuropathic pain and population ageing as well as the increase of survival of cancer treatment and systemic diseases as diabetes mellitus. Indeed, imbalances between excitatory and inhibitory somatosensory signaling, alterations in ion channels, and variability in the way that pain messages are modulated in the central nervous system have been implicated in neuropathic pain. The challenge of chronic neuropathic pain is linked to the complexness of neuropathic symptoms, poor outcomes, and consequently difficult treatment options. The importance of the medication and other medical treatment is directly connected with the quality of life in patients suffering from

*DOI: http://dx.doi.org/10.5772/intechopen.86770*

• Cervical pain disorders

**4.2 Primary headache disorders**

quently they are described together.

**4.3 Intraoral pain disorders**

glands), and bone.

**4.4 Neuropathic pain disorders**

[37, 38, 49, 50].


*Sleep and Orofacial Pain: Physiological Interactions and Clinical Management DOI: http://dx.doi.org/10.5772/intechopen.86770*

• Cervical pain disorders

*Updates in Sleep Neurology and Obstructive Sleep Apnea*

the important role of these general components.

depend on the specific type of pain [31].

**4. Orofacial pain diagnosis**

cians, and patients.

world [34, 35, 46, 47].

disorders that can cause similar symptoms.

• Primary headache disorders

• Neuropathic pain disorders

• Temporomandibular disorders

• Intraoral pain disorders

and Management of Orofacial Pain are as follows [36, 48]:

• Vascular and nonvascular intracranial pain disorders

hand, cortical responses to fast pain also seem to diminish after disturbed sleep. The relative balance of circadian versus homeostatic components in pain processing may

Although there is still a lack of knowledge on the orofacial pain-sleep interaction, basic and clinical evidence on both acute and chronic pain helps to elucidate

The ability to understand and investigate the pathophysiologic processes underlying a disorder, depends on a valid, reliable classification system and common terminology to facilitate communication among clinicians, researchers, academi-

A review of the literature regarding the classification of orofacial pain reveals a lot of classification systems with varying advantages and disadvantages [20–43]. Despite all these classifications, currently, the most accepted among the clinicians and researchers dedicated to orofacial pain is the Research and Diagnostic Criteria

The taxonomy of "Diagnostic criteria for temporomandibular disorders" (DC/ TMD) is an evolution of the original "Research diagnostic criteria for temporomandibular disorders" (RDC/TMD). It uses a dual-axis system in which, on Axis I, the physical diagnosis is based on pathophysiology and grading of chronic pain and on Axis II depression, anxiety, and non-specific physical systems are scored, in order to determine the distribution of subtypes of TMD, psychological disorders and psychosocial dysfunction [32, 33, 44, 45]. It is important to emphasize that with the advent of the RDC TMD, it was possible to describe and compare appropriate TMD subtypes and psychosocial profiles using clearly defined and validated diagnostic criteria in groups of TMD patients, and is used in different parts of the

An accurate orofacial pain diagnosis is obviously the first step to achieve the correct treatment for the patient. This means that the clinician must be aware of both the Axis I and Axis II of the DC/TMD. The diagnostic process involves defining the inclusion criteria that are specific to a disorder as well as ruling out specific

Establishing the correct diagnosis in orofacial pain is particularly difficult because of the complex inter-relationship of physical and psychological factors in the etiology of biopsychosocial chronic pain syndromes. Thus, the differential diagnosis is a critical process that—if failed—can often lead to an inappropriate treatment. The broad categories included in the new guidelines for Assessment, Diagnosis,

for temporomandibular disorders (RDC/TMD and DC/TMD).

**90**

• Extracranial and systemic causes of orofacial pain.
