Orofacial Pain (OFP): The Light at the End of the Tunnel

by Sherif Elsaraj, BSc, DMD, MSc

This editorial is dedicated to Dr John Miner, a dear friend and a colleague who has served the dental community since 1966. His positive energy and intellectual input will never be forgotten. Dr Miner was an active member of the Ontario Dental Association and the Ottawa Dental Society for 54 years. May his soul Rest In Peace.  

On March 31, 2020 the American Dental Association’s National Commission on Recognition of Dental Specialties officially recognized orofacial pain (OFP) as the 12th specialty in dentistry in the United States. Have you ever wondered what this means for the general dentist and the newly recognized (OFP) specialist? The aim of this editorial is to offer you a detailed snapshot of OFP, answer your most pertinent questions, offer some advice in a collegial way, and venture some answers, even if you need to read between the lines as to why I chose this field.

OFP can be generally defined as pain localized in the face and/or oral structures. It includes pain conditions such as odontogenic pain, temporomandibular disorders (TMDs), burning mouth syndrome (BMS) or trigeminal neuralgia, and headache disorders such as migraines, tension type headaches, or trigeminal autonomic cephalalgias. Chronic OFP is frequently associated with high psychological distress, disability, and poor quality of life with negative consequences on the individual and society at large.

Chronic pain has become a national health care crisis. It is the primary reason to seek care, the leading cause of disability and addiction, and the primary driver of healthcare utilization, costing more than cancer, heart disease, and diabetes. As a result, the nationwide chronic pain and opioid crisis is having a devastating effect on individuals, families, and communities, and imposing enormous financial costs on the government. Since 1999, the number of deaths from prescription opioids have more than quadrupled and is now over 40,000 deaths per year; a greater number than deaths from motor vehicle accidents. It is estimated that the cost to our communities and governments is at least $80 billion annually, with the financial impact on individuals and families even greater.

To date, a recognized OFP specialty only exists in a few countries (e.g. Australia, Brazil, Costa Rica, Sweden, South Korea), making it relatively difficult for general dentists to easily identify trained OFP practitioners to whom patients may be referred. An established specialty can support access to care by improving the visibility, awareness, and knowledge about OFP by the general public and by patients seeking treatment for it. OFP has been considered either as a subspecialty of more traditional dental specialties such as prosthodontics, orthodontics, oral medicine or oral surgery, or even of medical specialties, e.g. neurology. Fortunately, thanks to prodigious efforts from our predecessors, OFP now has its own comprehensive and international classification, and the number of countries that acknowledge OFP as a dental specialty is constantly growing. However, despite this progress, there is still a need for recognition of OFP within and outside of Dentistry, and the road ahead is filled with compelling challenges to improve OFP education.

About the Author

Dr. Sherif Elsaraj graduated from the University of Manitoba with a DMD in 2010. He holds a B.Sc. in Biochemistry from Carleton University and a Master of Science in Oral Biology from the University of Manitoba. In 2012, he completed a year of training at the Oral and Maxillofacial Radiology residency program at the University of Toronto. Dr. Elsaraj is currently doing research towards a PhD in Craniofacial Pain and Health Sciences at McGill University. He has limited his practice to treating TMD patients and sleep apnea management in Ottawa and at the Jewish General Hospital in Montreal.