Antidepressants for chronic orofacial pain.

The management of chronic orofacial pain has a history of therapeutic misadventures, charismatic-based treatment philosophies, controversies over the correct nomenclature, and a lack of scientific documentation. The dental profession has struggled to develop a systematic approach to nomenclature, treatment, and clinical research through numerous conferences, workshops, and consensus attempts. Despite these efforts, there is no generally accepted agreement on the etiology of chronic orofacial pain, its natural history, the role of occlusion, the need for aggressive treatment, or the effectiveness, safety, and indications for most current practices. These professional differences are often fostered by a lack of appreciation for the difference between clinical observations, which may form the basis for therapeutic innovation, and the need to verify the safety and efficacy of treatments in studies that control for factors that can mimic clinical success. This article describes the use of antidepressants as an example for the treatment of chronic orofacial pain. The treatment arose from the clinical observations of astute clinicians, but was subjected to scientific validation in well-controlled clinical trials.