The orofacial pain is one of the most frequent problems that see in the dental consultations.

In the cases of acute pain and especially when the pain emanates of dental, parodontic or mucous oral structures and the lesion is evident, the diagnosis is relatively easy and the local treatment of the lesion usually solves quickly the problem.

Less grateful are the cases of chronic pains, in those the causes are not anything clear and many times the treatments we use are not effective.

In this last situation are included, maybe as more frequent, pain deep musculoesqueletical (that frequently have effects of central excitement, as heterotopic pain, sympatic autonomous effects or secondary hyperalgesia); the miofascial trigger points and the TMJ arthralgia; and the neuropathic continuous pain, as the deafferentation pain or simpathetically maintained pain.

Many times, we classify these patients with chronic orofacial pain of "neurotic" or "difficult" and before the evidence of not being able to solve them the problem us to come undone of them in the way that is.

Does reason act this way with this type of patient?

The reasons can be many, but, I believe that there is a very important one: the dentists have forgotten that we make Medicine.

Most of these orofacial pain chronic dysfunctions are of medical type and require a basically medical boarding.

To treat these cases we need a formation in basic medical sciences: Neurosciences, Medical Pathology, Pharmacology, Psychiatry, etc; that many times we don't prepare.

To treat these patients we need a specific clinical history, with a very good anamnesis, a meticulous and complete exploration and some appropriate complementary exams that give us the enough data to make a correct diagnostic orientation.

The treatment of the chronic orofacial pain, many times, it requires a multidisciplinary boarding and we will need the physiotherapist's collaboration, psychiatrist, diagnostic for the image, maxillofacial surgeon, neurologist, etc.

A basic point will be to explain this circumstance to the patient and to make him see that its problem is not simply dental or oral and that to cure him it is needed a medical perspective and a multidisciplinary treatment.

Another possible reason for which we act this way before these types of dysfunctions is that our patients are accustomed to only reward our works of physical type or manual (cavities, restoring treatment, extractions, prosthodontics, orthodontics, etc.), but not those of mental type or of reasoning (clinical history, diagnostic orientation, treatment plan).

We also get used to act this way. Frequently, if we don't make them anything with our hands, we don't charge it.

To the long one, we end up thinking that the works of medical type, as those before mentioned, they are not lucrative and, maybe unconsciously, we reject them.

While we continue thinking it, won't change the way to approach the problems of our chronic orofacial pain patients.

We must claim our medical formation and, in consequence, we must use our non alone knowledge to work with the hands, but to think and to reason on the dysfunctions of our patients.

The cases of chronic orofacial pain that are basically a medical act, must be same or better rewarded that any purely mechanical work or manual.

This is little by little the philosophy that we must transmit, to our patients, if we want to assist them in a professional way when they consult us for problems of chronic orofacial pain.