engleski

Orofacial pain in dental practice: prevalence of neuropathic and musculoskeletal pain

Aims. In this study, the results of clinical diagnostics of the population with orofacial pain based on multidisciplinary diagnostics were evaluated. Methods. This population study consisted of 470 consecutive patients (mean age±SD was 41.7±17.8 years, range of age 10-88 years, 86% were female, gender ratio female: male was 6.1:1) who were referred to the Department of Removable Prosthodontics between 2001 and 2017. For the purpose of obtaining a differential diagnosis, a number of the patients were referred from the Clinic for Neurology and the Sestre milosrdnice University Hospital Center as a clinical basis for neuropathic orofacial pain. For patients with neuropathic pain and already established diagnoses, such as trigeminal neuralgia, it was necessary to determine possible comorbidity with TMJ-disorder. Results. Patients with TMJ-related diagnoses (n=340) have the largest share in patient population with orofacial pain in general. Of this, osteoarthritis diagnosis (which also includes the comorbidity disc displacement) is the most comprehensive diagnosis category (n=197 ; mean age 47.4±17.2). The patients with disc displacement followed (n=144 ; mean age 29.9±13.6). Only 35 patients had pains caused by trigeminal neuralgia (mean age 52.9±13.0). A statistically significant age difference was determined for all three subgroups, with females prevalent (chi-square test p < 0.001). There is also a comorbidity with trigeminal neuralgia (16 patients with osteoarthritis and one patient from the subgroup of disc displacement). Persistent idiopathic facial pain was found in subgroups with osteoarthritis (n=19) and disc displacement (n=1). The use of therapy depended on the type of diagnosis since one of the first choices for diagnosis of TMJ was a fabrication of the Michigan stabilization splint. In the subgroup of patients with trigeminal neuralgia, the treatment with anticonvulsant drugs was applied in 54.3% of patients, anticonvulsant drugs in combination with acupuncture in 25.7% of patients and the treatment by acupuncture alone in 17.1% of patients. Only one patient (2.95 %) was treated with opioid non-steroidal anti-inflammatory drugs. Conclusion. It is difficult to determine the prevalence of trigeminal neuralgia because the disease is often not recognized as neuralgia ; hence the symptomatology is in dental practice initially related to odontogenic pain of unclear etiology.

orofacial pain ; neuropathic pain ; temporomandibular pain

Clinic of Masticatory Disorders, Center of Dental Medicin, University of Zürich