Facial pain refers to the pain in the face, also called “facial pain” in Chinese medicine. There are many causes of pain, but three types of pain are more common in clinical practice: acute pulpitis, temporomandibular joint pain and trigeminal neuralgia. First, acute pulpitis accounts for a large proportion of the pain in the oral and maxillofacial region. Acute pulpitis is an acute inflammation of the pulp tissue, the source of infection is mainly from the deep pulp, and the infection of the pulp can cause apical infection through the apical foramen. The clinical characteristics of acute pulpitis are acute onset, the main feature is severe pain, the effect of general pain medication is not obvious, and the later stage can develop into pulp gangrene, and the treatment mainly consists of pulp opening and medication for pain relief. The main symptom of acute pulpitis (including acute attacks of chronic pulpitis) is severe pain, the nature of pain has the following characteristics: (1) spontaneous paroxysmal pain: in the absence of any external stimulation, sudden onset of severe spontaneous sharp pain, pain can be divided into a continuous process and relief process, the so-called paroxysmal attack or paroxysmal aggravation. In the early stages of inflammation, the pain lasts for a short period of time, while the relief lasts for a longer period of time, possibly two or three episodes within a day, each lasting several minutes. In late inflammation, the duration of pain is prolonged and may last for several hours or even a full day. The duration of relief is shortened or there are no intervals of pain at all. When the inflammatory pulp appears to be abscessed, the patient may complain of pulsating throbbing pain in the affected tooth. (2) Nocturnal pain: The pain tends to come on at night, or the pain is more intense at night than during the day. Patients often have difficulty sleeping due to toothache or wake up from sleep with pain. (3) Temperature stimulation aggravates the pain: cold or hot stimulation can stimulate severe pain in the affected tooth. If the tooth is in the middle of a painful episode, temperature stimulation can make the pain even worse. If the pulp is abscessed or partially necrotic, the tooth may show the so-called “hot pain and cold relief”. This may be due to the presence of gas in the pulp product, which expands when heated, resulting in a further increase in the pressure in the pulp cavity, thus producing severe pain. On the contrary, cold air or cool water can make the gas volume contract and reduce the pressure to relieve the pain. In clinical practice, it is common to see patients carrying cool water bottles to the clinic and gargling cold water at any time for temporary pain relief. (4) Pain cannot be localized by itself: most of the patients cannot clearly point out the affected tooth during the pain attack. The pain is diffuse or involved, often radiating along the distribution area of the 2nd or 3rd branch of the trigeminal nerve to the maxillary and mandibular teeth ipsilateral to the affected tooth or to the head, temporal and facial areas. However, this diffuse pain never spreads to the contralateral area of the affected tooth. When examined by the clinician, the affected tooth is usually found, for example, deep caries. It is seen at any age and without gender difference, with a recent history of periodontitis and caries, and the pain is persistent throbbing or swelling, aggravated at night, induced by hot or cold stimulation, without trigger point, and the affected tooth often has percussion pain. The most effective way to treat acute pulpitis is to open the pulp cavity of the focal tooth and perform pulp drainage, so that the inflammatory exudate in the pulp cavity is discharged, the pressure in the pulp cavity decreases and the pain is relieved. After the inflammation subsides, a perfect root canal treatment is then done. Second trigeminal neuralgia Trigeminal neuralgia is the most common maxillofacial nerve disorder, mainly manifested by recurrent episodes of severe pain in the distribution area of the trigeminal nerve on one side of the face. It occurs mostly in middle-aged and elderly people, more on the right side than on the left. The disease is characterized by sudden onset, stopping, lightning-like, cutting, burning, persistent, intolerable and severe pain in the trigeminal nerve distribution area of the face. The pain can be severe when speaking, washing the face, brushing the teeth or breezing the face, or even when walking. The pain lasts for several seconds or minutes, and it comes in periodic episodes, with intervals between attacks as in normal people. Secondary trigeminal neuralgia includes occupying brain lesions and vascular compression. The cause and pathogenesis of primary trigeminal neuralgia has not yet been clearly determined by Western medicine, while Chinese medicine believes that it belongs to liver and kidney problems. The attacks of trigeminal neuralgia are often unpredictable, and the pain attacks are usually regular. Each pain attack lasts only a few seconds to a few minutes and stops abruptly. At the beginning of the disease, the number of attacks is small and the interval is long, ranging from several minutes to several hours, but as the disease develops, the attacks become more frequent, the interval is gradually shortened, and the pain becomes more intense. The pain episodes decrease at night. There is no discomfort during the interval; however, talking, eating, washing face, shaving, brushing teeth and wind blowing can induce painful attacks, so that the patient is depressed, acts cautiously, and does not even dare to wash face, brush teeth, eat, and speak carefully for fear of causing attacks; the painful side can show spasms, i.e. “painful spasms”, frowning and clenching teeth, or using hands to cover eyes, The painful side may show spasms, i.e. “painful spasms”, frowning and clenching teeth, opening the mouth to cover the eyes, or rubbing the face with the palm of the hand to cause local skin roughness, thickening, loss of eyebrows, conjunctival congestion, tearing and salivation. Because trigeminal neuralgia mainly hurts in the teeth and face, there are often patients who cannot distinguish trigeminal neuralgia from toothache in clinical practice. Experts point out that many doctors may misdiagnose trigeminal neuralgia as toothache, and some patients even have a mouthful of teeth extracted, and the pain is still not cured. Therefore, it is important to confirm the diagnosis of trigeminal neuralgia. The traditional treatment is medication + surgery, which is an open procedure in which an opening is made to enter and cut out the painful trigeminal nerve. “But because the trigeminal nerve is a sensory nerve and is connected to the motor nerve, cutting it out through surgery can easily damage the motor nerve, which can lead to facial paralysis.” Most of the new techniques for treating trigeminal neuralgia are currently treated with painless trigeminal nerve thermal coagulation. The specific practice of trigeminal nerve radiofrequency thermal coagulation is to use radiofrequency temperature-controlled thermal coagulation needles at 70°C to “coagulate” the trigeminal nerve in a painless manner, so that no more nociceptive sensations are transmitted and pain does not occur. This procedure takes only 30 to 60 minutes, and the patient is awake and receiving treatment with little to no incision and low recurrence rate. Third Temporomandibular Joint Disorders Another common cause of face pain is temporomandibular joint disorder and temporomandibular arthritis. TMJ disorders are a general term for a group of clinical disorders that involve the masticatory muscles or (and) the temporomandibular joint and have some common symptoms (e.g., popping, pain, restricted mouth opening). TMJ disorders are characterized by three major clinical features: joint pain, joint popping murmur, and mouth opening restriction. The pain is mostly in the joint area or around the joint, and it increases when the mouth is open or painful. Some patients have non-specific symptoms such as tinnitus, headache, sensory abnormalities, and dizziness. The current treatment methods for TMJ disorder are conservative and surgical treatment. For the treatment of TMJ disorder, conservative treatment is generally adopted: treatment can be carried out through manual repositioning and injection of lubricating drugs such as sodium hyaluronate gel into the joint cavity; if necessary, a TMJ occlusion plate is worn to eliminate jaw abnormalities, relieve muscle tension, stabilize and improve jaw position, and reduce the compression of the condyle on the joint disc. Symptoms can usually disappear completely with about two months of treatment. Surgical treatment includes temporomandibular arthroscopic surgery and open surgery. TMJ arthroscopy is a minimally invasive procedure that can usually be performed under local anesthesia. This surgery has less damage to the temporomandibular joint. Compared with other traditional open surgery, it is minimally invasive, has a small incision, less surgical reaction, and can avoid facial nerve damage. Temporomandibular arthroscopy has a wide range of indications, including structural disorders of the temporomandibular joint, reversible or irreversible joint disc displacement, joint ankylosis, and osteoarthrosis. Symptoms of TMJ include local joint pain, ear pain, headache, murmur and pain during chewing, and are accompanied by pain in various muscles. Patients often have limited mouth opening and sometimes have difficulty swallowing food. For the treatment of TMJ arthritis, Dr. Qingbin Zhang introduces: TMJ arthritis must be treated with lavage of the joint cavity, followed by injection of sodium hyaluronate gel, and oral anti-inflammatory drugs for anti-inflammatory treatment. Compared to the pain caused by organic lesions occurring in other organs, face pain may not be a concern. However, patients suffering from these diseases are really in pain, which seriously affects their work and quality of life. But often these patients don’t know where to go or what kind of doctor they should see.