Differential Diagnosis of Orofacial and Jaw Pain: A Clinical Review for Physicians
Waseem A. Abboud, Tatiana Sella Tunis, Oren Peleg, Dror Shamir, Rania Elkhatib Fahoum, Shoshana Reiter, and Michael V. Joachim
AbstractOrofacial and jaw pain represents a diagnostic challenge frequently encountered across multiple medical specialties. Although odontogenic disease is a common cause of pain in the facial region, the present review focuses on non-odontogenic causes that should be considered when no clear dental source is identified or symptoms remain unexplained or persist despite appropriate dental treatment. Such pain may originate from the temporomandibular joints, masticatory muscles, cranial nerves, facial skeleton, adjacent head-and-neck structures, systemic diseases, or distant referred sources. This comprehensive review presents a systematic clinical approach to differential diagnosis, classifying non-odontogenic orofacial pain into ten distinct categories: temporomandibular joint disorders, masticatory muscle pain, skeletal disorders of the jaws, space-occupying lesions, infectious processes, neuropathic orofacial pain, idiopathic and nociplastic pain, orofacial pain resembling a presentation of primary headache, systemic diseases with orofacial mani¬festations, and referred orofacial pain from distant medical conditions. This classification aligns with the In¬ternational Classification of Orofacial Pain (ICOP-2020) while emphasizing practical clinical applicability for physicians across various specialties. Each category is characterized by unique clinical features, examination findings, and diagnostic considerations. Proper recognition of these patterns enables accurate diagnosis, appropriate treatment, and timely specialist referral when indicated. The approach emphasizes clinical assessment techniques accessible to physicians across various healthcare settings, focusing on detailed history-taking and physical examination. Identification of red flag symptoms requiring urgent evaluation is highlighted throughout. This systematic framework aims to reduce diagnostic errors, improve patient outcomes, and enhance interdisciplinary collaboration in managing complex orofacial pain presentations.