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Peer-reviewedCC BY 3.0Rambam Maimonides Medical Journal

Differential Diagnosis of Orofacial and Jaw Pain: A Clinical Review for Physicians

  • Waseem A. Abboud1,2,3
  • Tatiana Sella Tunis4
  • Oren Peleg1,5
  • Dror Shamir3
  • Rania Elkhatib Fahoum6
  • Shoshana Reiter7
  • Michael V. Joachim8,9
9 affiliations
  1. 1Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
  2. 2Department of Neurology, Institute of Movement Disorders, Sheba Tel-Hashomer Medical Center, Ramat-Gan, Israel
  3. 3Unit of Oral and Maxillofacial Surgery, Bnai Zion Medical Center, Haifa, Israel
  4. 4Department of Orthodontics, Goldschleger School of Dental Medicine, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
  5. 5Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  6. 6Department of Plastic Surgery, Bnai Zion Medical Center, Haifa, Israel
  7. 7Department of Oral Medicine, Goldschleger School of Dental Medicine, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
  8. 8Unit of Oral and Maxillofacial Surgery, Shamir (Assaf ha-Rofeh) Medical Center, Tzrifin, Israel
  9. 9Department of Plastic and Reconstructive Surgery, Shamir (Assaf ha-Rofeh) Medical Center, Tzrifin, Israel
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Abstract

Orofacial and jaw pain represents a diagnostic challenge frequently encountered across multiple medical specialties. Although odontogenic disease is a common cause of pain in the facial region, the present review focuses on non-odontogenic causes that should be considered when no clear dental source is identified or symptoms remain unexplained or persist despite appropriate dental treatment. Such pain may originate from the temporomandibular joints, masticatory muscles, cranial nerves, facial skeleton, adjacent head-and-neck structures, systemic diseases, or distant referred sources. This comprehensive review presents a systematic clinical approach to differential diagnosis, classifying non-odontogenic orofacial pain into ten distinct categories: temporomandibular joint disorders, masticatory muscle pain, skeletal disorders of the jaws, space-occupying lesions, infectious processes, neuropathic orofacial pain, idiopathic and nociplastic pain, orofacial pain resembling a presentation of primary headache, systemic diseases with orofacial manifestations, and referred orofacial pain from distant medical conditions. This classification aligns with the International Classification of Orofacial Pain (ICOP-2020) while emphasizing practical clinical applicability for physicians across various specialties. Each category is characterized by unique clinical features, examination findings, and diagnostic considerations. Proper recognition of these patterns enables accurate diagnosis, appropriate treatment, and timely specialist referral when indicated. The approach emphasizes clinical assessment techniques accessible to physicians across various healthcare settings, focusing on detailed history-taking and physical examination. Identification of red flag symptoms requiring urgent evaluation is highlighted throughout. This systematic framework aims to reduce diagnostic errors, improve patient outcomes, and enhance interdisciplinary collaboration in managing complex orofacial pain presentations.

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Cite

BibTeXRIS
BibTeX
@article{abboud2026differential,
  title = {{Differential Diagnosis of Orofacial and Jaw Pain: A Clinical Review for Physicians}},
  author = {Waseem A. Abboud and Tatiana Sella Tunis and Oren Peleg and Dror Shamir and Rania Elkhatib Fahoum and Shoshana Reiter and Michael V. Joachim},
  journal = {Rambam Maimonides Medical Journal},
  year = {2026},
  month = oct,
  doi = {10.5041/rmmj.10584},
  url = {https://doi.org/10.5041/rmmj.10584},
  note = {CC BY 3.0},
}
RIS
TY  - JOUR
TI  - Differential Diagnosis of Orofacial and Jaw Pain: A Clinical Review for Physicians
AU  - Waseem A. Abboud
AU  - Tatiana Sella Tunis
AU  - Oren Peleg
AU  - Dror Shamir
AU  - Rania Elkhatib Fahoum
AU  - Shoshana Reiter
AU  - Michael V. Joachim
PY  - 2026
DA  - 2026/10/26
JO  - Rambam Maimonides Medical Journal
DO  - 10.5041/rmmj.10584
UR  - https://doi.org/10.5041/rmmj.10584
AB  - Orofacial and jaw pain represents a diagnostic challenge frequently encountered across multiple medical specialties. Although odontogenic disease is a common cause of pain in the facial region, the present review focuses on non-odontogenic causes that should be considered when no clear dental source is identified or symptoms remain unexplained or persist despite appropriate dental treatment. Such pain may originate from the temporomandibular joints, masticatory muscles, cranial nerves, facial skeleton, adjacent head-and-neck structures, systemic diseases, or distant referred sources. This comprehensive review presents a systematic clinical approach to differential diagnosis, classifying non-odontogenic orofacial pain into ten distinct categories: temporomandibular joint disorders, masticatory muscle pain, skeletal disorders of the jaws, space-occupying lesions, infectious processes, neuropathic orofacial pain, idiopathic and nociplastic pain, orofacial pain resembling a presentation of primary headache, systemic diseases with orofacial manifestations, and referred orofacial pain from distant medical conditions. This classification aligns with the International Classification of Orofacial Pain (ICOP-2020) while emphasizing practical clinical applicability for physicians across various specialties. Each category is characterized by unique clinical features, examination findings, and diagnostic considerations. Proper recognition of these patterns enables accurate diagnosis, appropriate treatment, and timely specialist referral when indicated. The approach emphasizes clinical assessment techniques accessible to physicians across various healthcare settings, focusing on detailed history-taking and physical examination. Identification of red flag symptoms requiring urgent evaluation is highlighted throughout. This systematic framework aims to reduce diagnostic errors, improve patient outcomes, and enhance interdisciplinary collaboration in managing complex orofacial pain presentations.
SN  - 2076-9172
ER  -