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This guide provides a range of practice and evidence-based resources on the topic of orofacial pain.

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Last updated 21 August 2025

Guidelines and guides

The following guidelines and visual guides have been produced by the American Dental Association Science and Research Institute, the University of Pittsburgh, and the University of Pennsylvania.

Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in adolescents, adults, and older adults
This is a living guideline which is continually monitored and updated for the pharmacologic management of acute dental pain in adolescents, adults, and older adults. The first version of this guideline was published in February 2024.
Last evidence search: April 1, 2025.
Pulpitis Chairside Guide
Toothache / dental pain management in adolescent, adults and older adults with no immediate access to definitive dental care.
Toothache
A dosing guide with pain management options for adults with a toothache.
Tooth extraction / Tooth removed - simple and surgical
A dosing guide with pain management options for adults following a tooth extraction.
Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children
A guideline panel convened by the American Dental Association Council on Scientific Affairs, American Dental Association Science and Research Institute, University of Pittsburgh School of Dental Medicine, and Center for Integrative Global Oral Health at the University of Pennsylvania conducted a systematic review and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after 1 or more simple and surgical tooth extractions and the temporary management of toothache (that is, when definitive dental treatment not immediately available) associated with pulp and furcation or periapical diseases in children (< 12 years).
Pediatric Pulpitis Chairside Guide
Chairside guide for paediatric dental pain management without immediate care / temporary management of toothache in children with no immediate access to definitive dental treatment.
Postoperative Pain Chairside Guide
Chairside guide for postoperative pain after 1 or more simple or surgical tooth extractions in children.
Toothache - children
A dosing guide with pain management options for children with a toothache
Tooth extraction / tooth removed - simple and surgical - children
A dosing guide with pain management options for children following tooth removal.

Other guidelines and visual guides

Management of chronic pain associated with temporomandibular disorders: A clinical practice guideline
BMJ Rapid Recommendations.(2023, December). Management of chronic pain associated with temporomandibular disorders: A clinical practice guideline. BMJ, 383,e076227.
Management of painful Temporomandibular disorder in adults
Beecroft E., Palmer J., Penlington C., Avery L., Aggarwal V., Chase M., Davies S., Gerber B., Jagger R., Harrison S., Horton M., Jones L., Kalantzis A., Lie S., McKenna G., McMillan R., Morton M., Murphy E., Renton T., Thayer T., Weden A., Durham J. (2023). Management of painful Temporomandibular disorder in adults. NHS England Getting It Right First Time (GIRFT) and Royal College of Surgeons’ Faculty of Dental Surgery.
Orofacial pain and dentistry management: Guidelines for a more comprehensive evidence-based approach
Labanca, M., Gianò, M., Franco, C., & Rezzani, R. (2023, September). Orofacial pain and dentistry management: Guidelines for a more comprehensive evidence-based Approach. Diagnostics, 13(17), 2854. https://doi.org/10.3390/diagnostics13172854
Pharmacological management of orofacial pain – a clinician’s guide
Clark, M.V., Donnell, C.C., Durham, J., & Balasubramaniam, R. (2020, November). Pharmacological management of orofacial pain – a clinician’s guide. Oral Surgery, 13(4), 422-449. https://doi.org/10.1111/ors.12542

Books

Bell's Oral and Facial Pain, 7th ed., 2014
This textbook provides information concerning pain and pain behaviour so that one may better understand what pain is, how it behaves, and how it might best be managed; develops a useful classification of orofacial pain disorders; offers practical diagnostic criteria by which the different orofacial pain disorders can be identified on a clinical level; and suggests guidelines for the effective management of patients who suffer from pain in the region of the mouth and face. The concepts and techniques discussed are supplemented with case reports as well as, full-colour photographs and illustrations.
Craniofacial Pain. Temporomandibular Disorders and Beyond, 2024.
This book provides a broad, evidence based resource for all clinicians who encounter challenging patients suffering from TMDs. Common causes of craniofacial and myofascial pain of the head and neck, TMD treatment paradigms, and associated symptoms are explained. Background information on TMJ Anatomy, TMD Epidemiology and Pathology is given and advanced topics like therapeutic target and movement disorders and TMD are discussed.
Dentine Hypersensitivity. Advances in Diagnosis, Management, and Treatment, 2025.
This book, revised second edition, provides wide-ranging information on the progress achieved in the diagnosis, treatment, and management of dentine hypersensitivity during the past few years. Recent advances in research, including innovations in the development of desensitising agents, are fully described and detailed attention is paid to novel clinical approaches and potential future strategies in product development. Introductory chapters cover important aspects of physiology, prevalence and aetiology and advances in diagnosis and in vitro testing techniques for dentine hypersensitivity are discussed.
Diagnosing Dental and Orofacial Pain, 2016
This manual provides advice on ways to observe and communicate effectively with patients in pain, how to analyse a patient's pain descriptions and then provide a diagnosis of orofacial pain problems.
The companion website: www.wiley.com/go/moule/dental_and_orofacial_pain includes case studies, 22 short videos cited throughout the book, Clinical Pain Inventory Form, and a Personal Pain Plan by the Australian Pain Management Association.
Optimal Pain Management for the Dental Team, 2022.
Part of the BDJ Clinician's Guides, this book is a concise guide to the diagnosis and management of dental pain and anxiety. The 13 chapters cover psychology theories about pain, dentine sensitivity, hypersensitivity and cracked tooth syndrome. Chronic pain, temporomandibular disorders and local anaesthesia are discussed, and optimal medical and perioperative pain management explained.
Orofacial Disorders : Current Therapies in Orofacial Pain and Oral Medicine, 2017
This book provides evidence-based guidance on evaluation, diagnosis and management of a board spectrum of orofacial disorders. There is a specific chapter on 'Orofacial Pain Disorders' and another covering 'Health Care Approaches in Orofacial and Widespread Pains'.
Orofacial Pain : Guidelines for Assessment, Diagnosis, and Management - 6th ed, 2018
Consisting of 12 chapters, this book offers the latest research and most up-to-date information on orofacial pain, including a concise overview of each condition as well as its symptoms, comorbidities, differential diagnosis, and treatment options.
Pathway to Diagnosis and Management of Toothaches, 2024.
This book is a concise guide to the clinical examination and diagnosis of dental pain. It is focused on determining the root cause of pain to prevent an erroneous finding based on inadequate information provided by the patient or flawed interpretation of diagnostic testing. Readers will find guidance on anamnesis, clinical exams, and assessment of pain specific components of the mouth as well as on the progression of pulp diseases including the normal pulp, the inflamed pulp, necrobiosis and aerodontalgia. Information is provided on fractured tooth as well as on diagnostic tests for dental pain. The last part of the book is dedicated to periodontal pain and discusses the normal and inflamed periodontium, radicular periodontitis, apical periodontitis and endo-perio diagnosis.

Book chapters

Chapter 8. Diagnostic and Treatment Planning Considerations for Orofacial Pain in Physical Evaluation and Treatment Planning, in Dental Practice, 2nd ed., 2021
Chapter 9. I've got pain in my face, in Temporomandibular Disorders. A Problem-Based Approach, 2nd ed., 2021.
While references are made to the diagnosis and management of pain throughout the book, Chapter 9, using a case-study approach, specifically focuses on examination and differential diagnosis to determine best treatment options associated with pain. Also included is a list of questions to ask patients regarding pain.
Chapter 17. Non-Odontogenic Toothache and Chronic Head and Neck Pain, in Ingle's Endodontics, 7th ed., 2019
In addition to Chapter 17, see Part IX, 102. Pharmacologic Management of Periodontal Pain which includes a Decision Tree.
Tooth Pain in Dentistry Book - Family Practice Notebook
Provides a high-level overview of pathophysiology, causes, differential diagnosis and management of tooth pain.

Journals

Special issue: Dental Clinics of North America, 67(1), January 2023

Orofacial Pain Case Histories with Literature Review

Masticatory Myofascial Pain Disorders
Surgical Treatment of Temporomandibular Joint Derangement: 30-Year Follow-Up of Temporomandibular Joint Discectomy, a Case Report and Literature Review
Nonsurgical Management of Temporomandibular
Joint Arthropathy
Burning Mouth Syndrome
Continued persistent facial pain despite several surgical interventions in the temporomandibular joint
Persistent Idiopathic Dentoalveolar Pain: Is It a Central Pain Disorder?
Posttraumatic Trigeminal Neuropathic Pain in Association with Dental Implant Surgery
Trigeminal Neuralgia Pathology Mimicking Orofacial Pain
Head and Neck Cancer-Related Pain
Posttraumatic Stress Disorder and the Role of Psychosocial Comorbidities in Chronic Orofacial Pain
Challenges for the Dentist in Managing Orofacial Pain
Language Access and Orofacial Pain

Specialised journals on the topic

Journal of Oral and Facial Pain and Headache
Full text via DOSS.
Access available from 2014 onwards.
Journal of Dental Anesthesia and Pain Medicine
Full text, open access
Journal of Dental Anesthesia and Pain Medicine 2015 (v15 n1) to present
Previously Journal of Korean Dental Society of Anesthesiology 2001 (v1 n1) to 2014 (v14 4)

Journal articles

ADA News Bulletin, August 2023 No. 533

Dental Files: Prolonged Pain, 36-38
Facing pain head on, 40-41

Acute postoperative pain due to dental extraction in the adult population: A systematic review and network meta-analysis
Miroshnychenko A, Ibrahim S, Azab M, et al. (2023, January 11). Acute postoperative pain due to dental extraction in the adult population: A systematic review and network meta-analysis. Journal of Dental Research,102(4):391-401. doi:10.1177/00220345221139230
Biopsychosocial assessment and management of persistent orofacial pain
Penlington, C., & Ohrbach, R. (2020, November). Biopsychosocial assessment and management of persistent orofacial pain. Oral Surgery, 13(4), 349-357.
Imaging of orofacial pain
Whyte, A., & Matias, M.A.T.J. (2020, July). Imaging of orofacial pain. Journal of Oral Pathology & Medicine, 49(6), 490-498. https://doi.org/10.1016/j.joen.2020.12.002
Impact of a mindfulness-based intervention on pain and psychological factors in women with chronic painful temporomandibular disorders.
de Oliveira, M.M., LV, M., Díaz-Serrano, K., EBC, J., Fregni, F., KAP, B., Lacchini, R., Leite-Panissi, C., & Gherardi-Donato, E. (2025, August 6). Impact of a mindfulness-based intervention on pain and psychological factors in women with chronic painful temporomandibular disorders. Journal of oral rehabilitation. https://doi.org/10.1111/joor.70028
Interprofessional management of orofacial pain: Wearing many hats!
Avinash, B., Shivamallu, A.B., Ashwini, T.S., Sowmya, H.K., Ali, I., Kudagi, V.S., Shivamallu, A., & Kudagi, V. (2022, July). Interprofessional management of orofacial pain: Wearing many hats!. Journal of Pharmacy & Bioallied Sciences, 14(Suppl 1), S65-S67. https://doi.org/10.4103/jpbs.jpbs_556_21
Management of dental pain in primary care
Timmerman, A., & Parashos, P. (2020, April 1). Management of dental pain in primary care. Australian Prescriber, 43(2), 39–44. https://doi.org/10.18773/austprescr.2020.010
Management of pain in patients with temporomandibular disorder (TMD): Challenges and solutions
Gil-Martínez, A., Paris-Alemany, A., López-de-Uralde-Villanueva, I., & La Touche, R. (2018, March 16). Management of pain in patients with temporomandibular disorder (TMD): Challenges and solutions. Journal of Pain Research, 11, 571-587. https://doi.org/10.2147/jpr.s127950
Orofacial pain assessment and management for patients with dementia: A meta-ethnography
Geddis-Regan, A.R., Stewart, M., & Wassall, R.R. (2019, February). Orofacial pain assessment and management for patients with dementia: A meta-ethnography. Journal of Oral Rehabilitation, 46(2), 189-199. https://doi.org/10.1111/joor.12732
Pain management following dental trauma and surgical procedures
Malamed, S. F. (2023, April). Pain management following dental trauma and surgical procedures. Dental Traumatology, 39(4), 295–303. https://doi.org/10.1111/edt.12840
Postendodontic pain: A practical approach to diagnosis and management
Kohli, D., Falcon, C., Katzmann, G., Benoliel, R., Khan, J., & Korczeniewska, O.A. (2021, April 8). Postendodontic pain: A practical approach to diagnosis and management. Quintessence International, 52(5), 384-392.
Strategies for managing pain during endodontic treatment
Abbott, P.V., & Parirokh, M. (2018, August). Strategies for managing pain during endodontic treatment. Australian Endodontic Journal, 44(2), 99-113. https://doi.org/10.1111/aej.12249
Symptomatic irreversible pulpitis and other orofacial pain: overcoming challenges in diagnosis and management
Edwards, D., Allison, J.R., Coulter, J., Durham, J., & Beecroft, E.V. (2025, April 11). Symptomatic irreversible pulpitis and other orofacial pain: Overcoming challenges in diagnosis and management. British Dental Journal, 238(7), 517-526. https://doi.org/10.1038/s41415-025-8441-9
The voice of the patient in orofacial pain management
Häggman-Henrikson, B., Lobbezoo, F., Durham, J., Peck, C., & List, T. (2022, January). The voice of the patient in orofacial pain management. The Journal of Evidence-Based Dental Practice, 22(1). https://doi.org/10.1016/j.jebdp.2021.101648

Analgesics for the management of acute dental pain in the pediatric population: A systematic review and meta-analysis
Miroshnychenko, A., Azab, M., Ibrahim, S., Roldan, Y., Diaz Martinez, J. P., Tamilselvan, D., He, L., Urquhart, O., Tampi, M., Polk, D. E., Moore, P. A., Hersh, E. V., Carrasco-Labra, A., & Brignardello-Petersen, R. (2023). Analgesics for the management of acute dental pain in the pediatric population: A systematic review and meta-analysis. Journal of the American Dental Association (1939), 154(5), 403–416.e14. https://doi.org/10.1016/j.adaj.2023.02.013
Cannabinoid therapeutics in orofacial pain management: A systematic review
Votrubec, C., Tran, P., Lei, A., Brunet, Z., Bean, L., Olsen, B., & Sharma, D. (2022, September). Cannabinoid therapeutics in orofacial pain management: A systematic review. Australian Dental Journal, 67(4), 314-327. https://doi.org/10.1111/adj.12934
Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis
Miroshnychenko, A., Azab, M., Ibrahim, S., Roldan, Y., Diaz Martinez, J.P., Tamilselvan, D., He, L., Urquhart, O., Verdugo-Paiva, F., Tampi, M., Polk, D.E., Moore, P.A., Hersh, E.V., Brignardello-Petersen, R., & Carrasco-Labra, A. (2023, August). Corticosteroids for managing acute pain subsequent to surgical extraction of mandibular third molars: A systematic review and meta-analysis. Journal of the American Dental Association, 154(8), 727-741.e10. https://doi.org/10.1016/j.adaj.2023.04.018
COX-2 selective nonsteroidal anti-inflammatory drugs: what is their place in managing dental pain?
Moses G. (2025, August 12). COX-2 selective nonsteroidal anti-inflammatory drugs: what is their place in managing dental pain? Australian Prescriber, 48:145-6. https://doi.org/10.18773/austprescr.2025.036
Efficacy of oxycodone for postoperative dental pain: A systematic review and meta-analysis
Teoh, L., McCullough, M., & Taing, M.W. (2022, October). Efficacy of oxycodone for postoperative dental pain: A systematic review and meta-analysis. Journal of Dentistry, 125, 104254. https://10.1016/j.jdent.2022.104254
Injectable and topical local anesthetics for acute dental pain: 2 systematic reviews
Miroshnychenko, A., Ibrahim, S., Azab, M., Roldan, Y., Diaz Martinez, J.P., Tamilselvan, D., He, L., Urquhart, O., Tampi, M., Polk, D.E., Moore, P.A., Hersh, E.V., Carrasco-Labra, A., & Brignardello-Petersen, R. (2023, January). Injectable and topical local anesthetics for acute dental pain: 2 Systematic reviews. Journal of the American Dental Association, 154(1), 53-64.e14. https://doi.org/10.1016/j.adaj.2022.10.014
Opioids and the prism of pain management
Australian Dental Association Parma Advice. (2024, November). Opioids and the prism of pain management. ADA News Bulletin., 547, 10-13.
Orofacial pain management: An overview of the potential benefits of Palmitoylethanolamide and other natural agents
Santonocito, S., Donzella, M., Venezia, P., Nicolosi, G., Mauceri, R., Isola, G., Tsesis, I., Vassallo, A., & Steadman, K.J. (2023, April 9). Orofacial pain management: An overview of the potential benefits of Palmitoylethanolamide and other natural agents. Pharmaceutics, 15(4). https://doi.org/10.3390/pharmaceutics15041193
Pharmacological postoperative pain management for paediatric dental extractions under general anaesthesia: A systematic review
Ting, E.X.Y., Sethi, S., Jensen, E., & Poirier, B. (2025, January 15). Pharmacological postoperative pain management for paediatric dental extractions under general anaesthesia: A systematic review. Pain Research & Management, 2025. https://doi.org/10.1155/prm/8569846
Pharmacological postoperative pain management for paediatric dental extractions under general anaesthesia: A systematic review
Ting, E.X.Y., Sethi, S., Jensen, E., Poirier, B., & Valeriani, M. (2025, January). Pharmacological postoperative pain management for paediatric dental extractions under general anaesthesia: A systematic review. Pain Research and Management, 2025(1), 8569846. https://doi.org/10.1155/prm/8569846
Pharmacological therapy in the management of temporomandibular disorders and orofacial pain: A systematic review and meta-analysis
inervini, G., Franco, R., Crimi, S., Di Blasio, M., D'Amico, C., Ronsivalle, V., Cervino, G., Bianchi, A., & Cicciù, M. (2024, January 13). Pharmacological therapy in the management of temporomandibular disorders and orofacial pain: A systematic review and meta-analysis. BMC oral health, 24(1), 78. https://doi.org/10.1186/s12903-023-03524-8
Post-operative endodontic pain management: An overview of systematic reviews on post-operatively administered oral medications and integrated evidence-based clinical recommendations
Di Spirito, F., Scelza, G., Fornara, R., Giordano, F., Rosa, D., Amato, A., Nissan, J., & Chaushu, G. (2022, April 19). Post-operative endodontic pain management: An overview of systematic reviews on post-operatively administered oral medications and integrated evidence-based clinical recommendations. Healthcare, 10(5), 760. https://doi.org/10.1038/s41415-025-8441-9

Webinars

The following webinars are accessible via the ADA CPD Portal.

Orofacial Pain - Part 1: Introduction and clinical diagnosis
This video is the first in a four-part series that takes an in-depth look at the aetiology, diagnosis and management of orofacial pain. In part 1 of this series Dr Russell Vickers introduces the relationship between acute and chronic oral facial pain and relates this to the challenge of temporomandibular disorder pain management.
1 September 2017, 25m 04s.
Orofacial Pain - Part 2: Chronic neuropathic pain
This video is the second in a four part series that takes an in-depth look at oral facial pain aetiology, diagnosis and management. In part 2 of this series, Dr Russell Vickers describes the molecular and cellular mechanisms underpinning chronic neuropathic pain and how these relate to the presenting characteristics of different chronic neuropathic pain conditions.
1 September 2017, 39m 59s.
Orofacial Pain - Part 3: Pharmocotherapy
This video is the third in the four-part series that take an in-depth look at orofacial pain aetiology, diagnosis and management. In part 3 of this series, Dr Russell Vickers discusses and outlines the common medications used to manage orofacial pain, including herbal and emerging therapies.
1 September 2017, 32m 14s.
Orofacial Pain - Part 4: Stem cells & biomolecules clinical applications of stem cell therapy
This video is the final part of a four part series that takes an in-depth look at orofacial pain aetiology, diagnosis and management. In the final part 4, Dr Russell Vickers explains the potential use of stem cells as part of the management of orofacial pain conditions. Dr Vickers demonstrates patient outcomes of stem cell therapy and molecular therapy which is at the forefront of the current stem cell research outcomes.
1 September 2017, 28m 45s.

Podcasts

A real pain - Part 1
#ADA Dental Files Podcast, 1 April 2023, 19m 05s.
A patient in severe pain can really make a mess of your practice day. They of course need to be attended to quickly, and the logistics for doing so can be complicated. Beyond that, these cases can be difficult to diagnose and come up with a plan that addresses the pain, and critically, the underlying cause. Emeritus Professor Paul Abbott and Dr Peter Norton provide detailed guidelines for situations that are a real pain.
Prolonged pain management - Part 2
#ADA Dental Files Podcast, 24 June 2023, 14m 36s
In this follow up interview between Dr Peter Norton, and Professor Paul Abbot, Paul addresses another challenging scenario, that of patients who are struggling with pain post-treatment.
American Academy of Orofacial Pain - Podcasts
AAOP Educational Podcasts provide expert insights and the latest advancements in orofacial pain