Orofacial Pain

Orofacial Pain

Treatment for Orofacial Pain

The majority of infections that manifest in the orofacial region are odontogenic. Of these, approximately 70% present as periapical inflammation principally the acute dentoalveolar abscess, with the periodontal abscess following, etc

Acute infections of the orofacial region are due to the pathogenic activities of micro-organisms, including viruses, fungi, and bacteria. Surgical infection is mainly due to bacterial infection. The progress of any disease is governed by the host response to the invading organisms. Factors related to the body that are important include their number and virulence.


Diagnosis usually depends upon clinical examination and the patient’s history. What mainly concerns, especially in the initial steps, is the localization of the subject tooth. In the initial phase of infection, there is a soft growth of the soft tissues.

The tooth is also sensitive during palpation of the apical area and percussion with an instrument. In more advanced stages, the pain is exceptionally severe, even after the slightest contact with the tooth surface. Tooth reaction during a test with an electric viscometer is adverse; however, sometimes it appears positive, which is due to the conductivity of the fluid inside the root canal.

Radiographically, in the crucial phase, no signs are observed at the bone (which may be seen 8–10 days later). Unless there is a recurrence of a recurring abscess after that osteolysis is observed.

Signs of orofacial infection

The five classical signs of acute infection are diagnostic

  1. Swelling
  2. Redness
  3. Pain or tenderness
  4. Heat
  5. Loss of function
  6. Raised Body Temperature
  7. Rapid Pulse
  8. General Malaise

Ways of Infection

From the site of the initial lesion, inflammation may
spread in three ways:

  1. By continuity through tissue spaces and planes.
  2. By way of the lymphatic system.
  3.  By way of blood circulation.


If the infection is not treated promptly, the following complications may occur

  1. trismus, 
  2. lymphadenitis at the respective lymph nodes, 
  3. osteomyelitis, 
  4. bacteremia, 
  5. septicemia.

Required Actions

A Clear and concise medial history is recorded with special regard to metabolic or blod disorders. In very acute, recurrent or persistent infections, special investigations should be performed such as

  • Urinalysis
  • Haemoglobin
  • Full blood count and differential white cell count-leucocytosis
  • Fasting blood suger
  • Blodd cultures
  • Erythrocyte sedimentation rate

The decision when to perform various procedures is of great importance and requires considerable experience. In acute infection with a high temperature, immediate treatment with antibacterial drugs should be commenced. If pus has localised this must be drained without delay and cultuFre and sensitivity tests performed. Antibacterial drugs can be started blind and continued until the results of the sensitivity tests are available. If not possible before, the cause should be removed as soon as the acute phase has passed.