Orofacial pain – diagnostic and therapeutic challenges

Abstract

The concept of diagnostics and therapy of musculoskeletal and neuropathic diseases of the stomatognathic system, which are the subject of this paper, has been developing for decades. It can be said that in order to avoid misunderstanding, the orofacial pain as a clinical problem, in the narrower sense, involves non-odontogenic and non-malignant causes of orofacial region. In this study, the results of clinical diagnosis of the population of 557 consecutive patients with orofacial pain based on multidisciplinary diagnostics were evaluated. 15.6% of patients have given up on the participation in the study. It has been shown that the patients who dropped out of the study were significantly older (p=0.0411) than those who agreed to participate, but there was no difference in gender ratio (p=0.185) since the proportion of female patients prevailed. In an analysis of 84.4% of patients participating in the study, the elevated anxiety values were established (mean value on STAI 1 was 39.2 and STAI 2 was 41.1) and statistical significance was found in correlation between elevated anxiety and intensity of pain as shown on visual analogue scale on open mouth (p<0.0001). Compared to the age, the statistical significance was for STAI 1 (p=0.0097) but not for STAI 2 (p=0.5599). The most common form of therapy is Michigan stabilization splint: for disc displacement of temporomandibular joint (TMJ) in 38.9% of patients and in combination with physiotherapy in 18.7% of patients; for osteoarthritis of TMJ in 28.4% and in combination with physiotherapy in 26.4% of patients. The treatment with anticonvulsant drugs for trigeminal neuralgia predominates in 54.3% of patients, which is combined with acupuncture in 25.7% of patients and only acupuncture in 17.1% of patients. In this study, a multidisciplinary cooperation in initial diagnostics and differential was designed to develop subspecialist knowledge on orofacial pain.

Self-perceived competence of dental students regarding the management of orofacial pain: a cross-sectional study

“…The most common cause of orofacial pain is of odontogenic origin and comes under the domain of dental medicine and should not be a diagnostic-therapeutic challenge in itself. On the other hand, non-odontogenic causes of orofacial pain include musculoskeletal, neuropathological diseases, temporomandibular disorders (TMD), neuralgias, ENT diseases, tumours, and neurovascular pain or psychiatric diseases [ 4 , 5 ]. These conditions usually present overlapping signs and symptoms and present a diagnostic dilemma for the clinician who usually treats the patient for dental pain [ 4 , 5 ].…”

“…On the other hand, non-odontogenic causes of orofacial pain include musculoskeletal, neuropathological diseases, temporomandibular disorders (TMD), neuralgias, ENT diseases, tumours, and neurovascular pain or psychiatric diseases [ 4 , 5 ]. These conditions usually present overlapping signs and symptoms and present a diagnostic dilemma for the clinician who usually treats the patient for dental pain [ 4 , 5 ]. Arriving at the correct diagnosis is of crucial importance to guide the delivery of appropriate treatment.…”

“…Arriving at the correct diagnosis is of crucial importance to guide the delivery of appropriate treatment. Initiating treatment without sufficient attention to the complex mechanism of pain may result in unnecessary treatment without eliminating the problem [ 4 , 5 ]. In Pakistan, no national data exist regarding the prevalence of orofacial pain.…”

“…In Pakistan, no national data exist regarding the prevalence of orofacial pain. However, studies on the local population reported a 30% prevalence of OFP in 11–14-year-old [ 5 ]. Similarly, 43% prevalence of OFP was reported among patients visiting the dental hospitals in Karachi [ 6 ].…”

Review of Literatures: Physiology of Orofacial Pain in Dentistry

“…The third spinal nucleus of the CN V is the pars caudalis or trigeminal nucleus caudalis ( Christoforou, 2018 ; Klasser et al, 2018 ) which carries the pain perception of this involved area. Then the signals will be further projected to the third order neurons in the thalamus via the ventral trigeminothalamic tract ( Joseph, 1982 ; Rivera-Morales, 1986 ; John, 1990 ; Roberts, 1991 ; van der Bilt et al, 2006 ; Wilkinson, 2014 ; Badel et al, 2019 ).…”