Source-bound perceptual persistence in chronic orofacial symptoms: a hypothesis framework

Persistent orofacial symptoms often remain locally compelling, disabling, and treatment-resistant when their ongoing burden is insufficiently explained by current nociceptive input, neurogenic pathology, or other identifiable peripheral findings. This narrative, theory-driven review develops source-bound perceptual persistence as a hypothesis-generating framework for understanding such conditions across pain-dominant, dysaesthetic, and occlusal-percept presentations. The central construct is source dominance in perceptual persistence: the extent to which a suspected orofacial source continues to organize perception, action, treatment seeking, clinical reasoning, and expectations of recovery. The framework is informed by four partially overlapping literatures concerning signal availability in sensory and pain systems, symptom-perception mechanisms of credibility and failed updating, orofacial sensorimotor mechanisms of active resampling, and clinical embedding mechanisms of source stabilization. We propose that chronic orofacial persistence may arise through a recurrent maintenance loop in which sensory evidence remains available, becomes credible as bodily evidence, is repeatedly resampled through oral action, and becomes clinically or biographically embedded around a suspected orofacial source. The framework helps explain why pain, burning, pressure, dysaesthesia, occlusal wrongness, or other orofacial experiences may differ in sensory quality and in their dominant mechanisms, yet converge when they remain perceptually real, accessible to repeated oral testing, and clinically actionable. Source-bound perceptual persistence is proposed as an integrative maintenance framework for generating empirically testable hypotheses about how chronic orofacial symptoms remain organized around suspected sources when current peripheral findings no longer adequately explain the ongoing symptom burden.

Orofacial pain; Perceptual persistence; Symptom perception; Occlusal dysesthesia; Persistent dentoalveolar pain; Burning mouth syndrome; Temporomandibular disorder; Nociplastic pain; Source attribution; Active sampling

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