Managing orofacial pain in practice

  • E. Murphy
UK: Quintessence price £28.00; pp 170 ISBN 9781850971306 | ISBN: 978-1-8509-7130-6

This is a recent addition to the highly acclaimed Quintessentials of Dental Practice series. This book aims to aid the general dental practitioner in the assessment, diagnosis and management of orofacial pain as well as identifying cases where it may be best to refer for further investigation. It has a firm clinical emphasis. A foreword written by Nairn Wilson summaries the complex and challenging nature of managing a patient with orofacial pain. We can all recall having been drawn into providing irreversible treatment for a patient in pain where no diagnosis has been able to be made. An important point raised for such a case is 'No diagnosis, no treatment'.

Dental disease is by far the most common cause of orofacial pain therefore a dental cause should first be excluded in all cases. The assessment, diagnosis, management and treatment of many conditions are covered. These include: TMJ disorders, bruxism, myogenic pain, neurovascular pain eg migraine, giant cell arteritis, cluster headache and neuropathic eg trigeminal neuralgia. The signs and symptoms of these different conditions can often be misinterpreted. Tables, illustrations and well written text are used to clearly differentiate between them.

A very useful point highlighted was the importance of psychological factors such as depression, anxiety and somatisation on treatment outcome. Studies have found the presence of premorbid psychological trauma an important indicator of the risk of developing chronic pain. Such factors may include: physical or sexual abuse, neglect or loss of a parent. Taking a detailed social history is important as early referral maybe indicated as such factors will impede treatment outcome. Accurate diagnosis is essential in the acute phase to prevent the pain becoming chronic as the longer pain is present psychological factors plays a dominant role. Another interesting point is that there is no link between the severity of the initial injury and the development of chronic pain and 80-100% of chronic pain sufferers are depressed.

Case presentations are present at the beginning of each chapter and the final chapter is dedicated to this. Examples of cases include: 'I cannot open my mouth' and 'My toothache will not go away'.

This book is an excellent, comprehensive clinical reference invaluable for every general dental practitioner. With the aid of this book one would hope a correct diagnosis can be made so the patient receives the best treatment as soon as possible and where referral is needed this is done early and appropriately. Improving our knowledge and understanding of these conditions should improve our patients understanding and therefore acceptance of their condition.