[MUSIC] Welcome. In this segment we will discuss various aspects of orofacial pain. This entire segment consists of several segments which focus on different aspects of orofacial pain. We will start with the review of the goals and objectives of the entire segment. We will then discuss introductory material regarding orofacial pain that will lay the foundation for the remainder of the segments. We will review pertinent aspects of disease models, such as the biomedical model In the bio-psychosocial Bio-behavioral model in the context of orofacial pain. This segment will be followed by discussions on specific orofacial pain conditions that main be encountered in general healthcare practice. We will start with a discussion of temporomandibular disorders, abbreviated as TMDs, which will consist of disease facts and figures, and a review of relevant anatomical structures. This will be followed by a discussion on clinical evaluation methods for patients with suspected TMD. We will then review common types of TMD, such as articular disc disorders, arthritic conditions, and masticatory muscle disorders with strategies for management. Our subsequent discussions will focus on trigeminal neuralgia. And persistent idiopathic facial pain, which are two types of neuropathic pain disorders. The goals and objectives of this entire segment are to understand the role of axis one and axis two factors in orofacial pain conditions, appreciate the biomedical and biopsychosocial biobehavioral Models of disease. And to increase fundamental knowledge for evaluation and management of patients with temporomandibular disorders, trigeminal neuralgia, and persistent idiopathic facial pain. With this understanding, let us begin with an introduction to orofacial pain. To understand orofacial pain in a clinical context, should have an appreciation of having classification. Simple pain refers to pain complaints from the patient which are highly subjective require advanced knowledge of pain behavior to effectively manage these patients. Concepts such as heterotopic pain, which refers to when the site of the pain is not in the same location as the source of the pain, and central excitatory effects, which refers to diagnostic differentiation between true primary pain and symptoms that occur as secondary effects of that pain are factors as to why referral of complex pain patients to pain specialists is often warranted. In order for clinicians to fully classify a pain disorder, they must consider both the somatosensory input and the psychosocial input. Therefore, a more comprehensive classification of pain must take these two factors into account. And is the reason why pain is often considered to have two axies. The first axis of pain we will discuss is axis one. This axis refers to the physical condition that accounts for the pain experience by the patient. There are many components to the orofacial structure and any one of them may become dysfunctional and give rise to pain symptoms. The various structures of this region include cutaneous and mucogingival tissues, the pharynx, nose, and paransal sinuses, dental structures, musculoskeletal structures of the mouth and face, visceral structures of the mouth and face, and neural structures of the mouth and face. Clinicians should make every attempt to evaluate these structures as potential sources of pain. The second axis of pain is axis two or psychological conditions. There are numerous psychological conditions that may produce and/or influence a patient's pain experience. Psychological problems frequently encountered in orofacial pain populations include anxiety disorders, depression, and mood disorders. Patients with somatoform disorders display physical signs of pain, which may be extremely debilitating without an identifiable physical cause for symptoms. Finally, patients may develop psychological disorders related to medical conditions. An example of this is a patient who is recently diagnosed with a life altering condition who develops anxiety and depression because of their primary diagnosis. It is imperative to consider both axis one and axis two factors in the evaluation and management of orofacial pain disorders as each axis can exert significant influence on the management and prognosis of the condition. If these axises are not considered together, it is likely that treatment outcomes will be less than optimal for patients with orofacial pain disorders. The term orofacial pain typically represents both acute and chronic conditions. Acute orofacial pain commonly arises from a dental and or a periodontal source. Patients with oralmucosal legions and or salivary gland disorders may experience acute pain. All of the common sources of acute orofacial pain should be evaluated and managed by the appropriate healthcare provider. Many acute orofacial pain conditions will resolve with appropriate therapy. Unfortunately, many patients suffer from chronic orofacial pain conditions, and obtain numerous consultations with healthcare professionals for management of their condition. Approximately 25% of the general population has experienced acute or chronic orofacial pain. Chronic orofacial pain refers to painful regional syndromes with a chronic, unremitting pattern. These conditions display a wide array of symptoms, typically with patients suffering from months to years. Patients with a history of chronic orofacial pain commonly report Undergoing extensive diagnostic testing, often recommended by multiple healthcare providers, without receiving a definitive diagnosis. They also commonly reporting having received several types of therapeutic modalities for their condition without substantial benefit. Patients with chronic orofacial pain may appear to be anxious or depressed regarding their condition. Approximately 10% of all orofacial pain cases will be consistent with a chronic condition. When considering the differential diagnosis of chronic orofacial pain conditions, one may group them into three broad categories, musculoskeletal pain, neuropathic pain, and neurovascular pain. The most common type of chronic orofacial pain condition classified as a musculoskeletal disorder is temporomandibular disorder, which we will discuss in greater detail in subsequent segments. Neuropathic pain may be considered a pain caused by a lesion or disease of the somatosensory nervous system, despite the fact that many cases of neuropathic pain do not have identifiable pathology associated with them. Trigeminal neuralgia and persistent idiopathic facial pain are two common types of neuropathic pain conditions that we will discuss in more detail in subsequent segments. Neurovascular pain is representative of neurologic and vascular structure interactions, with trigeminal autonomic cephalgias and migraine headache included in this category. Most common type of trigeminal autonomic celphagias is cluster headache, which consist of headache with nerve pain and autonomic features such as tearing or sweating. Migraine headache is a specific type of headache disorder with specific clinical features, which are often confused with tension type headache, formerly known as muscle tension headache. Further discussion of neural vascular pain is beyond the scope of this presentation. Following this introduction we will discuss psychological and behavioral aspects of orofacial pain.