Orofacial Pain in Dogs

Orofacial pain is just that, pain affecting your dog’s facial area.  It can occur constantly or may only occur occasionally if brought on by stress or eating.  Most patients with this condition present with exaggerated licking and chewing with pawing at the face, head, and mouth.  Your veterinarian will be able to diagnose your dog by observing her symptoms and after performing a physical exam.  Additional lab work may be suggested to verify the condition and to rule out possible causes.  If treated properly in accordance with your dog’s specific needs, he should make a full recovery.  If you do not treat him, his symptoms will progress and self-mutilation may continue.

Orofacial pain is commonly found in cats but can be diagnosed in dogs as well, just less frequently.  If your dog is experiencing any of the symptoms such as lack of appetite or exaggerated chewing, it would be a good idea to have him evaluated by his veterinarian.

Symptoms of orofacial pain may include:

• Gingerly eating
• Lack of appetite
• No longer interested in playing with hard toys
• Exaggerated licking 
• Exaggerated chewing
• Pawing at the mouth, face, and head
• Self-inflicted facial trauma 
• Can be episodic and brought on by eating
• Avoidance of petting/affection

Types

Orofacial pain can affect your dog anywhere on his face but is typically located near the mouth.  There are various nerves running through his face and numerous muscles that all interconnect and therefore, feel discomfort.  The impact of the discomfort can range from mild to severe.  Every dog will react to his own case as an individual.

Dental disease is one suspected cause of orofacial pain in dogs.  However other causes such as trigeminal neuropathy, dermatologic diseases, and behavioral factors should also be considered as possible causes.  

Possibly, the cause goes deeper.  Some studies involving felines document the orofacial pain syndrome is actually focal seizures caused by oral or facial lesions.  Many of the cats in the study responded well to phenobarbital therapy.  Imaging including an MRI and CSF did not indicate any abnormalities nor did anything show up on any autopsies.

Your veterinarian will begin by performing a full physical exam on your dog.  While the issue may be with his face, she will want to check for additional symptoms that may be subtle to the untrained eye.  She will also collect a verbal history from you; she will want to know when the pain started, if it has been progressing, if it is constant or intermittent, and similar questions.  Your veterinarian will want to check in your dog’s mouth and the back of his throat for any type of foreign object that may be causing his discomfort.  In order to do this, your dog may need to be sedated temporarily in order for the veterinarian to perform a thorough evaluation.

Your dog’s home life also needs to be evaluated.  Stress can induce orofacial pain in some patients and therefore his environment may be contributing to his condition.  Your veterinarian may ask you extensive questions about his home life and daily routine to see if it contributes to his condition.

It is likely your veterinarian will need to come to her diagnosis by a rule out basis.  This means she will run diagnostics and the results will allow her to narrow down to the ailment your pet is experiencing.  Diagnostic testing will include basic blood work consisting of a complete blood count (CBC) and chemistry panel to check for any abnormalities within the blood or organ levels.  This will be helpful when trying to assess what is going on internally.  

Imaging will also be helpful when it comes to orofacial pain.  A radiograph can get a basic picture to rule out of your cat has a fracture of some sort around his face.  A more detailed image such as an MRI may be more delicate and therefore present a better view of the nerves and how they are functioning.  Facial sensation needs to be properly assessed to check for the trigger area, sensitivity, and even possible paralysis if present.

Treatment for your dog will be focused on reducing the neuropathic pain he is experiencing.  Gabapentin, in addition to anti-inflammatory medications, have been shown to offer the pet relief in some cases.  The gabapentin decreases or completely stops the seizures while the anti-inflammatory offers a pain relief.  

You will also need to ensure you eliminate the stressors from your dog’s life.  To do this you can provide a variety enrichment to keep his mind busy focused on something else.  Your dog may need temporary bandaging or e-collars to prevent further self-trauma.  While he may not like it at first, most dogs adapt to it and are able to function with it on no problem.  It is usually the owner who feels bad for their pet and takes it off; do not do this.  Your dog will be perfectly fine with it on and will prevent him from continuing to mutilate himself.  

If you are unable to keep your dog’s stress level low no matter what you try, you may need medication to alter behaviors of anxiety and stress.  Veterinarians typically like this as a last option and will recommend other options first.  You can look into homeopathic and other natural remedies for your pet’s stress.  Certain options have seen high rates of success.  

It is also a good idea to document your pet’s behavior.  Keep a journal of your pet’s behaviors.  When did he have an episode?  What was going on that day?  Was there anything or anyone new in the home?  Was the weather bad?  Did the lawn people come?  These are all things that can stress your dog without you realizing it.  Keeping a journal will be an easy way to check for patterns regarding your dog’s issue.

If you are able to eliminate the source of your dog’s stress, it will help reduce the severity of his condition.  However, if it is caused by mini-seizures, medications may be required to offer your dog some relief.  If you do not treat your dog, his condition is likely to worsen as the pain may increase with time and repeated self-mutilation.  However, with proper treatment, your dog should make a full recovery.