Pain Guidelines

The recent International Classification of orofacial pain provides several groups of orofacial pain;

1. Orofacial pain attributed to disorders of dentoalveolar and anatomically related structures Maria Pigg, Sweden (chairman); Alan Law, USA; Donald Nixdorf, USA; Tara Renton, UK; Yair Sharav, Israel

2. Myofascial orofacial pain Peter Svensson, Denmark (chairman); Malin Ernberg, Sweden; Chris Peck, Australia

3. Temporomandibular joint (TMJ) pain Per Alstergren, Sweden (chairman); Ghabi Kaspo, USA; Frank Lobbezoo, Netherlands; Ambra Michelotti, Italy

4. Orofacial pain attributed to lesion or disease of the cranial nerves Lene Baad-Hansen, Denmark (chairman); Eli Eliav, USA; Yoshiki Imamura, Japan

5. Orofacial pains resembling presentations of primary headaches Rafael Benoliel, USA (chairman); Paulo Conti, Brazil; Arne May, Germany

6. Idiopathic orofacial pain Thomas List, Sweden (chairman); Justin Durham, England; Jean-Paul Goulet, Canada; Satu Ja¨a¨skela¨inen, Finland

7. Psychosocial assessment of patients with orofacial pain Richard Ohrbach, USA

We have provided dedicated sections to each of these diagnostic groups for your information; You must bear in mind that many of these chronic conditions are rare and still the most common pain in the orofacial region is toothache.

Differential diagnosis is an issue particularly for dentists identifying patients with rare chronic pain conditions and often mis treating the patients as if they have toothache. Often rendering the patients with multiple unnecessary dental procedures.

We use a diagnostic sheet to record specific diagnoses of our patients.

The prevalence of OFP in adults is between 10-15%, based on the available evidence this rate increases over time (Häggman-Henrikson et al., 2020). Most patients with chronic pain, including those in the orofacial area, experience poor sleep quality (Lavigne & Sessle, 2016; Whibley et al., 2019). Furthermore, the study conducted by Meira et al. (2019) concluded that one in three patients diagnosed with OFP experience sleep disorders. Good sleep quality is essential in maintaining mental and physical health (Yuksel et al., 2021). A minimum of one review has examined different aspects of BMS, TN, and PTNP every year; however, none of them evaluated the association between these OFP and sleep quality.


Prevalence/Incidence of OFP Diagnoses – Tara Renton KCL

Toothache Prevalence estimates for 5 case definitions identified were: ‘toothache’, ‘pain in teeth with hot, cold or sweet things’ 25-38%, ‘pain and discomfort needing medication or treatment’ 7-9%, ‘pain or discorfort in the mouth, teeth or gums’ 19-66%, and ‘oral and facial pain’40-44%. Pau AK, Croucher R, Marcenes W Prevalence estimates and associated factors for dental pain: a review. Oral Health Prey Dent, 2003;1(3):209-20

Tension type headache Episodic TTH,occurring on fewer than 15 days per 7-32%month, is reported by more than 70% of some populations

Migraines 22.7% in the National Health and Nutrition Examination Survey, 16.6% of adults 18 or older reported having migraine or other severe headaches in the last 3 months in the 2011 National Health Interview Survey. In contrast, the AMP study found an overall prevalence of migraine of 11.7% and probable migraine of 4.5%, for a total of 16.2%. Smitherman TA, Burch R, Sheikh H, Loder E.The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013 Mar;53(3):427-36. doi: 10.1111/head.12074, Epub 2013 Mar 7.

Temporo mandibular joint disorders (MD ) Males / Females 6.7% / 12.4% Johansson et al, 2002

Dentine sensitivity 11.5% (95%C1:11.3%-11.7%) (Favaro Zeola L, Soares PV, Cunha-Cruz J. Prevalence of dentin hypersensitivity: Systematic review and meta-analysis. I Dent. 2019 Feb;81:1-6. doi: 10.1016/j.jdent.2018.12.015. Epub 2019 Jan 11. PMID: 30639724.)

Post traumatic Painful neuropathic pain/PTNP Chronic post surgical V pain Incidence 0.01-20% of patients undergoing third molar surgery/ 1:14-54k post LA block / ? Post Implants

Persistent Dentoalveolar Pain (PDAP) incidence 1.6% -5%

Burning Mouth Syndrome (BMS) prevalence 0.1% (Incidence over 55 years (3.7%), 11 men (1.6%) and 42 women (5.5%)] Bergdahl M Bergdahl J Burning mouth syndrome: prevalence and associated factors. 1 Oral Pathol Med. 1999 Sep;28(8):350-4.

Non traumatic secondary neuropathy???

Trigeminal neuralgia (TIN) General population 0.1% and 0.3%, although studies carried out in primary care settings suggest that it may be much higher, around 12% per 100,000 persons per year

Fayaz et al 2016; Renton 2015; Nixdorf & Moano-Filho 2011;Kohorst etal 2015;Mueller et al 2015