COMMENTARY

How Often Do Dentists See Orofacial Pain?

Eric T. Stoopler, DMD

Disclosures

November 30, 2015

Prevalence of Pain in the Orofacial Regions in Patients Visiting General Dentists in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry Research Network

Horst OV, Cunha-Cruz J, Zhou L, Manning W, Mancl L, DeRouen TA
J Am Dent Assoc. 2015;146:721-728

Orofacial Pain

Oral healthcare professionals are responsible for the evaluation, diagnosis, and management of conditions affecting the oral cavity and perioral structures.[1,2,3] Expert care is routinely taken to evaluate the dentition, periodontium, and all other hard and soft intraoral tissues; however, dental professionals must also examine other structures of the face, head and neck because these regions are within the scope of dental medicine.[1]

Orofacial pain may arise from a variety of local and/or regional anatomic sources and is a common reason for patients to seek care. This study sought to measure the prevalence of pain in the orofacial regions and determine association with variables such as demographics, treatment history, and oral health conditions in dental patients visiting clinics in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) research network in the United States.

A cross-sectional study of orofacial pain, oral health conditions of patients, and treatment performed by general dentists in their clinics was conducted from 2006 to 2009. Participating patients were selected using a systematic random sampling scheme with sampling intervals adjusted for patient volume so that each dentist was expected to sample no more than two patients per day. After obtaining informed consent from a participating patient, the dentist collected standardized data on diagnosis and treatment of oral conditions, specifically addressing the presence of orofacial pain during the past 12 months, from oral examination, patient interview, and review of the dental chart. Data abstracted from the charts were classified as follows:

  • Dentoalveolar—pain in the tooth and surrounding tissues, including dental and periodontal abscesses, irreversible pulpitis, and other tooth-related pain;

  • Musculoligamentous—pain in the orofacial muscles, ligaments, and temporomandibular joints, including arthralgia, myalgia, or pain associated with temporomandibular disorders, capsulitis, and arthritis;

  • Soft tissue—pain in the orofacial soft tissues including aphthous ulcers, herpes, and burning mouth syndrome; or

  • Nonspecific areas—diffuse pain, sinus-like pain, or pain due to orthodontic treatment.

One hundred general dentists participated in the study with enrollment of 1668 patients. The distribution of orofacial pain categories and dentist and patient characteristics were examined using descriptive statistics. The results of the study were:

  • The prevalence of orofacial pain during the past 12 months was 16.1% (95% confidence interval [CI], 13.4%-18.9%);

  • The most frequently reported pain location was the dentoalveolar region (9.1%; 95% CI, 7.0%-11.2%) followed by musculoligamentous tissues (6.6%; 95% CI, 4.5%-8.7%);

  • The prevalence of dentoalveolar pain was highest in the age range of 30-44 years with slightly higher reporting frequency in men compared with women;

  • The prevalence of musculoligamentous pain was highest in the age range of 18-29 years with substantially higher reporting frequency in women compared with men;

  • Ethnicity was not related to the prevalence of dentoalveolar and musculoligamentous pain;

  • Patients who were not scheduled for a dental maintenance visit (examination, prophylaxis, or preventive treatment) were more likely to report dentoalveolar pain whereas type of visits (maintenance vs nonmaintenance) were not associated with the prevalence of musculoligamentous pain; and

  • General dentists younger than age 31 years were the most frequently reported age demographic to see patients experiencing dentoalveolar pain.

Viewpoint

The results of this study suggest that the most common types of orofacial pain complaints encountered by general dentists arise from dentoalveolar and musculoligamentous structures. Orofacial pain conditions are often challenging to diagnose and manage due to the complex, multifaceted nature of these disorders. Patients can present with a constellation of painful signs and symptoms that may arise from several anatomic sources, which is often coupled with biopsychosocial factors, making diagnosis and management of orofacial pain conditions extremely difficult.

These scenarios are played out in dental offices on a daily basis and often leave both clinician and patient frustrated and disappointed. Although the results of this study should be generally appreciated by oral and general healthcare providers, it should be acknowledged that all general dental practices may not be representative of the study results based on practice demographics (provider age, patient age, prevalence of comorbid conditions, etc.) and location (urban vs rural setting, community-based public clinic vs private clinic, etc.).

It is important for oral healthcare providers to consider such structures as the temporomandibular joint and muscles of mastication as sources of referred pain to the dentoalveolar structures. A basic examination of the temporomandibular joint and muscles of mastication should be conducted in patients complaining of orofacial pain symptoms because disorders affecting these structures can refer pain directly to the dentition or periodontium.[4]

Dental professionals may initiate dental procedures to address pain symptoms thought to arise from the dentition or periodontium without clear evidence that these interventions are warranted. In many of these cases, the patient's original pain complaints remain unchanged or worsen after the dental treatment has been completed because the primary source of pain arises from musculoligamentous structures.

Providers should also be familiar with clinical symptomatology representative of neuropathic pain conditions, such as trigeminal neuralgia and persistent idiopathic facial pain (atypical odontalgia) because these disorders are considered to be within the spectrum of orofacial pain conditions.[5]

Efforts should be made to enhance training in orofacial pain diagnosis and management in pre- and postdoctoral dental curricula and through continuing education to provide optimal care for patients.

Abstract

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