Dolor orofacial en niños: el diagnóstico que suele pasar desapercibido

Orofacial Pain in Children: The Diagnosis That Often Goes Unnoticed

Orofacial pain in the pediatric population is more common than believed, but it remains underdiagnosed. Many children lack the language to explain what they feel, confusing it with “headache,” “tiredness,” or simply getting used to the discomfort.
As dentists, we have a unique opportunity to identify early signs, especially when understood from the perspective of function, posture, and breathing.

Why is childhood orofacial pain overlooked?

  • Children express pain differently
  • They confuse areas (head, ear, neck, jaw)
  • It is wrongly assumed that "children do not have muscle pain"
  • Dental consultations focus on teeth, not function
  • Many symptoms are interpreted as "misbehavior"
  • Sleep problems are seen as behavioral issues

A child who does not sleep well, clenches, breathes poorly, or has chronic muscle tension can indeed have orofacial pain.

Main causes of pediatric orofacial pain

  1. Bruxism: Increases muscle load, especially in masseters, pterygoids, and temporalis.
  2. Chronic oral breathing: Alters muscle balance and forces the jaw to compensate.
  3. Bad oral habits: Fingers, objects, tongue thrust, pacifier.
    Muscles work in inefficient patterns.
  4. Sleep problems: Non-restorative sleep increases pain sensitivity and muscle fatigue.
  5. Postural alterations: Forward head posture, poor cervical stability, unilateral chewing.
  6. Restrictive frenula: Low tongue posture creates compensations in suprahyoids.
  7. Emotional causes: Stress, academic demands, anxiety, sensory challenges.

How orofacial pain manifests in children

  • Recurrent headaches (frontal or temporal)
  • Pain when chewing hard foods
  • Avoiding using certain sides for chewing
  • Complaining of "tiredness in the jaw"
  • Waking up irritable
  • Frequently touching their face or temples
  • Difficulty opening the mouth in the morning
  • Jaw noises
  • Selective eating behaviors

Comprehensive clinical evaluation

1. Muscle palpation adapted for pediatrics

Gently evaluate: masseters, temporalis, suprahyoids.

2. Observation of breathing pattern

  • Does the child breathe through the nose or mouth?
  • Is there obvious nasal obstruction?

3. Sleep review

  • Snoring
  • Awakenings
  • Night sweats
  • Visible bruxism

4. General posture

Forward head, tense shoulders, low tongue posture.

5. Orofacial function

Chewing, swallowing, lip seal.

Common diagnostic errors

❌ Attributing pain to “teething”
❌ Thinking the child is exaggerating
❌ Prescribing splints without evaluating function
❌ Not asking about sleep
❌ Not exploring breathing

When to intervene

  • Recurrent pain
  • Impact on eating
  • Bruxism associated with pain
  • Fragmented sleep
  • Persistent muscular signs

Transdisciplinary approach

Collaborate with:

  • Speech-language pathology
  • ENT
  • Orofacial physiotherapy
  • Child psychology
  • Sleep medicine

Conclusion

Orofacial pain in children is real, frequent, and clinically relevant. Early identification changes the child's experience and the evolution of the orofacial system.

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