Orofacial pain

Orofacial pain (OFP) remains a significant clinical challenge due to its complex neurobiological foundations, overlapping symptom patterns, and diverse etiologies. Recent advances in research have substantially broadened our understanding of temporomandibular disorders (TMD), neuropathic and idiopathic facial pain, sleep-related behaviors, autoimmune contributors, and the genetic factors that influence individual vulnerability. As global populations age, idiopathic and nociplastic OFP in older adults has gained increasing relevance. This demographic shift underscores the importance of recognizing how central sensitization, psychosocial factors, polypharmacy, and common comorbidities interact to shape the clinical presentation and therapeutic needs of this group.

Given its multifactorial nature, OFP can be profoundly disabling and diagnostically demanding. Contemporary literature emphasizes the value of structured sensory examinations, advanced imaging modalities, and early mechanism-based diagnostic frameworks to improve clinical accuracy. Parallel advancements in pharmacologic treatments and interventional strategies, particularly targeted neuromodulation, reflect a growing movement toward precision-oriented care. The development of biologically guided therapies, improved imaging protocols, and updated criteria for minimally invasive procedures further highlight the importance of integrating objective diagnostic findings with patient-reported outcomes to optimize therapeutic success.

A rapidly evolving area within the field involves OFP genetics. Emerging evidence demonstrates that specific genetic variations influence pain processing, inflammatory responses, connective tissue integrity, and neural repair mechanisms. These discoveries help clarify why some individuals develop TMD or neuropathic facial pain while others with similar exposures do not. Understanding these genetic contributions not only deepens etiologic insight but also supports the ongoing alignment of OFP management with broader trends in precision medicine.

Overall, the message is clear: effective OFP care requires a biopsychosocial, interdisciplinary, and mechanism-driven approach. As the knowledge base expands, clinicians must translate emerging evidence into practice to enhance diagnostic accuracy, diversify treatment strategies, and improve patient outcomes. Continued collaboration across research and clinical disciplines will be essential as the field progresses.

Acknowledgements

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Frontiers of Oral and Maxillofacial Medicine for the series “Orofacial Pain”. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://fomm.amegroups.com/article/view/10.21037/fomm-2025-1-47/coif). The series “Orofacial Pain” was commissioned by the editorial office without any funding or sponsorship. JK served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Frontiers of Oral and Maxillofacial Medicine from June 2024 to May 2026. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.