September is Pain Awareness Month. This campaign aims to increase understanding of pain, pain management, and the experiences of people living with pain according to the International Association For the Study of Pain. 

Dr. Seema Kurup, associate professor, division of oral medicine and orofacial pain at the UConn School of Dental Medicine, answers questions about orofacial pain in honor of the awareness month. 

Q: When people hear “orofacial pain” they usually think of TMD. Is that accurate? 

It’s fair, and honestly, it’s not a bad place to start — temoporomandibular disorder (TMD) is the condition most people have heard of. TMD is really just the entry point. Orofacial pain as a field covers a lot more territory than that, and some of it gets missed for years because nobody’s looking for it outside a dental lens. 

Q: You’ve mentioned ENT providers are getting better at recognizing TMD. What’s changed? 

It has been encouraging. More ear nose and throat (ENT) colleagues now understand that TMD can show up as ear pain, tinnitus, fullness, headaches, even pain radiating into the neck and shoulder. So, a patient walks into an ENT’s office convinced something is wrong with their ear, and increasingly, that provider knows to ask about jaw symptoms too. That kind of cross-specialty awareness is exactly what we need more of, just applied to a wider set of conditions. 

Q: What’s an example of a condition that gets missed because of that dental– versus– medical divide? 

Painful post-traumatic trigeminal neuropathy is a good one — or PTTN, for short. It can develop after something as routine as an extraction, an implant placement or even a root canal treatment. The procedure itself heals fine, but the nerve doesn’t, and the patient is left with burning or tingling pain or altered sensations that can show up inside the mouth or out on the face. Too often the patient ends up back in the dental chair for more treatment when what they actually need is neuropathic pain management. 

Q: What about conditions where there’s nothing visible on exam at all? 

That’s burning mouth syndrome, and it’s a tough one for patients. They’re describing this persistent burning, usually on the tongue, and the clinician looks in and sees nothing. No lesion, no infection, nothing to point to. It’s easy for that to get brushed off or bounced between providers because there’s no obvious culprit. But it’s a real, recognized diagnosis with real management options — it just requires knowing to name it rather than dismiss it. 

Q: You also mentioned migraines and dystonia showing up in the face and jaw. Can you explain? 

Orofacial migraine is exactly what it sounds like: migraine physiology, but the pain lands in the face, jaw, or even the teeth instead of the head. Patients sometimes go through multiple dental workups before anyone considers migraine as the actual source. Oromandibular dystonia is a bit different — that’s involuntary jaw muscle contractions sometimes very painful, and it’s often mistaken for a straightforward temporomandibular joint (TMJ) problem when it’s really a movement disorder. 

Q: If there’s one message, you’d want clinicians to take away this Pain Awareness Month, what would it be? 

Widen the lens. TMD awareness has genuinely improved, and that’s worth celebrating. But orofacial pain is a much bigger than TMD alone, and a lot of these patients are out there right now bouncing between providers without a diagnosis that fits. If a patient’s pain doesn’t add up with what you’re seeing on exam, that’s not a dead end — that’s usually the moment to think beyond the obvious and consider a neuropathic, idiopathic, or neurovascular cause instead. 

Q: Is there anything else you think gets overlooked when we talk about these conditions? 

Yes, and it’s important — most orofacial pain patients are chronic pain patients by the time they get to me. They’ve often been dealing with this for months or years, seeing provider after provider, and not getting real answers. That takes a toll. They are frustrated, their quality of life has taken a hit, and that frustration doesn’t stay contained to just the pain itself. It spills over into anxiety, depression and sleep issues. So, when I am treating someone with orofacial pain, I am rarely just treating a jaw or a nerve. I am treating a person whose whole life has been affected by living with pain that, in a lot of cases, took too long to even get named.