Kroniska smärttillstånd i ansiktsregionen

Kronisk ansiktssmärta, i synnerhet temporo- mandibulär dysfunktion (TMD), är vanlig hos den vuxna populationen. Symtomen kan över- lappa smärtor från tänder och parodontium. Det är därför viktigt att tandläkaren kan diagnosti- sera och behandla de vanligast förekomman- de kroniska smärttillstånden. Denna artikel be- handlar TMD och neuropatiska ansiktssmärtor såsom persisterande idiopatisk ansiktssmärta och atypisk odontalgi, trigeminusneuralgi och posttraumatisk trigeminusneuropati. De se- naste kunskaperna om patofysiologi presente- ras med en beskrivning av evidensbaserade be- handlingsmetoder.Considerable progress has been made during the last decades in the understanding of the processes involved in facial pain. The complexity and multidimensionality of pain is increasingly comprehended, and more insights have been gained into the risk factors predisposing to chronic pain. In addition, improved and more reliable diagnostic systems and approaches have been introduced, and some advances have been made in the treatment of certain facial pain entities, such as neuropathic facial pains. However, many aspects of facial pain are still poorly understood, and much needs to be done to validate many of the methods used to treat facial pain, and to develop new improved, more effective treatment approaches with fewer side effects. Science is advancing rapidly in the field of pain, including facial pain. The special areas of interest in facial pain research include molecular biology, biomarkers, imaging, genetics, and pain and psychological comorbidities, amongst others. It is to be expected that increased understanding of pain mechanisms and other aspects of facial pain will in the future bring some novel therapeutic possibilities. For our patients a correct treatment is of uttermost importance. Treatment of chronic pain disorders have to be based on correct diagnosis and evidence based treatment modalities. The future will most probably also witness the rise of personalized pain medicine, whereby treatments are customized to fit each patient’s pain and psychosocial, as well as genetic characteristics. In the light of rapid advances in the field of pain, much more emphasis should be put on pain education in the dental curriculums