[The patient with chronic and/or complex orofacial pain: history taking and diagnostic examination]

Abstract

Diagnosing chronic orofacial pain can be a time-consuming, complicated and challenging task. Therefore a structured interview and clinical examination are essential to capture all key elements of the evaluation. A thorough understanding of clinical conditions that can present in the orofacial region is obviously fundamental. Key elements of the history taking include questions about the location, onset, duration, frequency, quality and intensity of the pain, precipitating, aggravating and relieving factors, and associated symptoms. The goal of the clinical examinations is to elucidate the source of the pain. One should remember that the source of the pain does not always coincide with the site where the patient experiences the pain. A thorough examination should include a cranial nerve evaluation, evaluation of the cervical as well as masticatory musculature, the cervical spine, the temporomandibular joints and the intra-oral tissues. Additional diagnostic tests may include diagnostic injections with local anesthesia, radiographs or other imaging techniques, laboratory tests or psychologic/psychiatric evaluation.