[Chronic orofacial pain; atypical facial pain?]

Difficult to diagnose pain in the orofacial area may be a challenge to the dental practitioner. There still is uncertainty about the taxonomy of chronic orofacial pain, and even more so about its etiology. Treatment of chronic orofacial pain may aim at goals which are set in advance, but also at the underlying pain mechanisms. The disentanglement of pain into different pain mechanisms may be facilitated by applying a pharmacodiagnostic test. This test consists of intravenously administering several medications in low doses in orofacial pain patients. The response to the administration of these pharmaca is reported by means of a visual analogue scale (VAS) for pain. The profile, resulting from the consecutive VAS-scores, may be used as a guide for further treatment. Before the start of any treatment, the dentist should judge whether he himself is able to treat the patient or referral to a specialist is required.