Orofacial pain after invasive dental procedures: neuropathic pain in perspective

The neurologist is very familiar with the painful neuropathies of the trunk and extremities but, generally, to a lesser extent with those of the head and face. Of the latter, the neurologist is particularly familiar with ophthalmic zoster and trigeminal neuralgia.

This review deals with neuropathic orofacial pain: (1) to highlight its presentation; and (2) to contrast it with that of neuropathic pain elsewhere in the body, including the head, from which it seems to differ significantly. The reason for the difference is also discussed as well as its implications for the diagnosis of orofacial pain as neuropathic. In the cases of neuropathic orofacial pain presented, the pain followed invasive dental procedures, making it relatively homogenous in terms of its etiology. The cases are contrasted with those of cranial nonorofacial and of noncranial painful neuropathy.

It is suggested that the presence of abnormal sensory responses to touch, in the sense of paresthesia, dysesthesia, or allodynia, is a prerequisite for the diagnosis of neuropathic pain, when other, motor or sensory, signs of nerve injury ordinarily guiding the diagnosis are lacking, as is often the case in the face.