1. 1 Differential Diagnosis of Orofacial Pain By S. Wanachantararak

2. 2 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

3. 3 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

4. 4 Vascular Origin Orofacial Pain Migraine Headache Cluster Headache Peroxymal hemicrania Vascular Headache

5. 5 History Examination of Orofacial Pain

6. 6 History Ex. of Orofacial Pain 1. Chief complaints A. Location of pain B. Onset of pain – – Association with other factors – – Progression C. Characteristics of pain – Quality of pain – Behaviour of pain – Temporal – Frequency – Duration – Intensity – Concomitant symptoms – Flow of pain

7. 7 History Ex. of Orofacial Pain 1. Chief complaints (cont.) D. Aggravating and alleviating factors – – Physical modalities – – Function and parafunction – – Sleep disturbances – – Medications – – Emotional stress E. Past consultation and/or treatment F. Relationship to other complaints 2. Past medical history 3. Review of systems 4. Psychological assessment

8. 8 Clinical Examination of Orofacial Pain

9. 9 Clinical Examination 1. General examination A. Vital signs – – Blood pressure – – Pulse rate – – Respiratory rate – – Temperature B. Cranial nerve evaluation C. Eye evaluation D. Ear evaluation E. Cervical evaluation F. Balance and co- ordination 2. Muscle examination A. Pulpation – Pain and tenderness – Trigger points and pain referal

10. 10 Clinical Examination 3. Masticatory evaluation A. Range of mandibular movement – – Measurement – – Pain B. Temoromandibular joint evaluation – – Pain – – Dysfunction C. Oral structures – Mucogingival tissues – Teeth – Periodontium – Occlusion 4. Other diagnostic tests A. Imaging B. Laboratory tests C. Psychologic provocation tests

11. 11 Pain from Intraoral Origin

12. 12 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

13. 13 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

14. 14 Pain for Intraoral Origin

15. 15 Pain for Intraoral Origin

16. 16 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

17. 17 Pain for Intraoral Origin

18. 18 Pain for Intraoral Origin

19. 19 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

20. 20 Pain for Intraoral Origin

21. 21 Pain for Intraoral Origin

22. 22 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

23. 23 Pain for Intraoral Origin

24. 24 Pain for Intraoral Origin

25. 25 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

26. 26 Pain for Intraoral Origin

27. 27 Pain for Intraoral Origin

28. 28 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis Pain from oral mucosa

29. 29 Pain for Intraoral Origin

30. 30 Pain for Intraoral Origin

31. 31 Non Vascular Origin Orofacial Pain

32. 32 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

33. 33 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

34. 34 Non Vascular Origin Orofacial Pain

35. 35 Non Vascular Origin Orofacial Pain

36. 36 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

37. 37 Non Vascular Origin Orofacial Pain

38. 38 Non Vascular Origin Orofacial Pain

39. 39 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

40. 40 Non Vascular Origin Orofacial Pain

41. 41 Non Vascular Origin Orofacial Pain

42. 42 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

43. 43 Non Vascular Origin Orofacial Pain

44. 44 Non Vascular Origin Orofacial Pain

45. 45 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

46. 46 Non Vascular Origin Orofacial Pain

47. 47 Non Vascular Origin Orofacial Pain

48. 48 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

49. 49 Non Vascular Origin Orofacial Pain

50. 50 Non Vascular Origin Orofacial Pain

51. 51 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

52. 52 Non Vascular Origin Orofacial Pain

53. 53 Non Vascular Origin Orofacial Pain

54. 54 Vascular Origin Orofacial Pain

55. 55 Vascular Origin Orofacial Pain Migraine Headache Cluster Headache Peroxymal hemicrania Vascular Headache

56. 56 Vascular Origin Orofacial Pain Migraine Headache Cluster Headache Peroxymal hemicrania Vascular Headache

57. 57 Vascular Origin Orofacial Pain

58. 58 Vascular Origin Orofacial Pain

59. 59 Vascular Origin Orofacial Pain Migraine Headache Cluster Headache Peroxymal hemicrania Vascular Headache

60. 60 Vascular Origin Orofacial Pain

61. 61 Vascular Origin Orofacial Pain

62. 62 Vascular Origin Orofacial Pain Migraine Headache Cluster Headache Peroxymal hemicrania Vascular Headache

63. 63 Vascular Origin Orofacial Pain

64. 64 Vascular Origin Orofacial Pain

65. 65 Vascular Origin Orofacial Pain Migraine Headache Cluster Headache Peroxymal hemicrania Vascular Headache

66. 66 Vascular Origin Orofacial Pain

67. 67 Vascular Origin Orofacial Pain

68. 68 Pain for Intraoral Origin Pain from Dentine Pain from Pulp Pain from Gingiva Pain from Periodontatitis Pain from Periapical periodontitis

69. 69 Non Vascular Origin Orofacial Pain Pain from Teeth (pulp) Pain from TM muscle Pain from TMJ Sinusitis Salivary gland Trigeminal Neuralgia Atypical Neuralgia

70. 70 Vascular Origin Orofacial Pain Migraine Headache Cluster Headache Peroxymal hemicrania Vascular Headache

71. 71 Thank You