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Epidemiology of orofacial pain: A retrospective study

Article  in  Journal of Advanced Clinical and Research Insights · January 2015

DOI: 10.15713/ins.jcri.34

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 Journal of Advanced Clinical & Research Insights (2015), 2, 12–15

ORIGINAL ARTICLE

Epidemiology of orofacial pain: A retrospective study

Akshay Shetty1, Leena James2, Tejavathi Nagaraj2, Marin Abraham2
1
Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India, 2Department of Oral Medicine and
Radiology, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India

Keywords Abstract
Epidemiology, orofacial pain, pulpitis, Background: The orofacial pain is a pervasive situation either of somatic or psychological
trigeminal system
etiology arising from the structures supplied by the trigeminal nerve. Identifying the
cause of orofacial pain goes a long way in diagnosis and treatment.
Correspondence
Dr. Akshay Shetty, Department of Oral and
Objectives: To evaluate the cause of pain among the subjects reporting to the dental college.
Maxillofacial Surgery, Sri Rajiv Gandhi College Materials and Methods: A retrospective study was conducted on a group of patients
of Dental Sciences, Cholanagar, RT Nagar with persistent facial pain with an ebb to respond properly to previous treatments were
Post, Bengaluru - 560 032, Karnataka, India. assigned to specialists associated with Department of Oral Medicine and Radiology
Phone: +91-9845477547, Email: akshay7978@ and Oral and Maxillofacial surgery in Sri Rajiv Gandhi College of Dental Sciences and
rediffmail.com Hospital from March 2010-April 2011.
Results: It was found that pulpitis was the most common cause of orofacial pain followed
Received 07 August 2014; by periodontal pain. Neuralgias and TMJ disorders were the least likely cause.
Accepted 18 October 2014 Conclusion: Multidisciplinary approaches and a biopsychosocial model of pain
management are an essential adjunct to established evidence-based medical and surgical
doi: 10.15713/ins.jcri.34
management of these conditions

Introduction to diagnosis. Thus, the study is targeted to verify the number of

Pain is defined as “an unpleasant sensory and emotional
experience associated with actual or potential tissue damage by
activation of nociceptors, which transmits a noxious stimulus
to the brain.”[1] The field of dentistry has introduced a detailed
study over a number of years for the betterment of a group of
subjects who had experienced orofacial pain, but were unable to
appreciate its genesis.[2]
Conveyance of pain by the trigeminal system
Pain sensation from the intraoral and extraoral structures of
the head and face are carried to the central nervous system
by the trigeminal system, which consists of both sensory and
motor innervations [Figure 1]. Sensory information from the
face and mouth is carried by primary afferent neurons through
the trigeminal ganglion to synapse with second order neurons
in the trigeminal brain stem complex which receives afferent
neurons and axons from the facial, glossopharyngeal, vagus,
and the upper cervical (C2, C-3) nerves originating “orofacial
pain [Figure 2].”[3,4]
Background and objectives
Assessing the severity of pain the subject encounters are essential
cases reported with pain complaints.[5]
Methodology
A retrospective study was conducted on a group of patients
with persistent facial pain with an ebb to respond properly to
previous treatments were assigned to specialists associated
with Department of Oral Medicine and Radiology and
Oral and Maxillofacial surgery in Sri Rajiv Gandhi College
of Dental Sciences (SRGCDS) and Hospital from March
2010-April 2011. The records of 2200 consecutive patients
were analysed, where 1298 were females, and 902 were males.
Patients were selected according to the history of the chronic
pain symptoms and classified according to the criteria of the
international association for the study of orofacial pain. This
study was carried out with the approval of the institution’s
research Ethical Committee. The patient’s data were obtained
as per their medical records in the Orofacial Pain Clinic,
SRGCDSH. Consistency was maintained was maintained in
the interview method by trained graduate students who applied
standardized questionnaires and a systematic evaluation of
cranial, facial, cervical, dental, and other oral structures in
accordance to a definite clinical pattern to detail: (a) Chief

12 Journal of Advanced Clinical & Research Insights  ●  Vol. 2:1  ●  Jan-Feb 2015
Shetty, et al. Retrospective study of orofacial pain

complaint; (b) characteristics exhibited by the pain, if the chief
complaint is pain (location, intensity, quality, duration, time of
pain severity); (c) incidence of headache (d) medical history
of the patient. This was followed with a thorough evaluation
based of clinical and roentgenographic assay.[5,6]
Number of patients under study
The study was conducted with 2200 patients with a complaint
of orofacial pain who resided in the nearby rural and urban areas
[Table 1].

Study period and study location Results

The study was conducted on the patients who visited Oral and
Maxillofacial Surgery Department of SRGCDS, Bangalore from
March 2010 to April 2011.
Figure 1: Conveyance of pain by trigeminal system
Results of international epidemiologic studies indicate that
the orofacial pain occurs in approximately 10% of the adult
population with a greater predilection to women [Graph 1]. Most
studies show a decline of prevalence in older age. Based on the
oro facial pain study was conducted. Overall, 2200 patients were
evaluated. Mean age of the total sample was 33.5 ± 13.8 years,
being 33.9 ± 13.9 for females and 31.7 ± 13.1 for males. In total
59% (1300) of the orofacial pain patient group were females and
41% (900) males; indicating at higher prevalence of orofacial
pain in the female group [Table 2].
Most prevalent reason for orofacial pain in the study patient
group was Pulpitis with 946 or 43% of the patients. A total of
704 patients or 32% had periodontal pain as a reason for orofacial
pain. Relatively low percentage of patients 286 or 13% had
pericoronitis as a reason for the pain whereas victims affected
by temporomandibular joint (TMJ) disorder. Dysfunction and
neuralgia were 176 or 8%.
“Others” categories were the least observed with 88 or 4%
of the patients. This group comprised of persons suffering from
traumatic injuries, squamous cell carcinoma, salivary gland
carcinoma, craniofacial pathology neoplasm, etc., [Graph 2].
The aforementioned trend was followed in the male and
female gender group as well with 49% of females and 47% of
males having pulpitis as the primary reason for orofacial pain.
Relatively higher percentage of male patients had periodontal
pain as a reason for orofacial pain. At an overall level for both
male and females pulpitis was the main reason for orofacial pain
[Table 3].

Table 1: Differential diagnosis of pain frequently observed in orofacial region[6]

Idiopathic trigeminal Pulpitis Orofacial Temperomandibular
neuralgia (referred dental pain) neoplasia disorders
Pain Electric, shock like Throbbing Variable (atypical) Dull, stabbing
Pain duration Seconds Minutes‑hours Variable Minutes‑hours
Intensity Severe Slight‑severe Severe Moderate
Localization Good Diffuse Diffuse Good, diffuse
Characteristics Triggerzone‑diurinal Diurinal or nocturnal Referred pain frequently, TMJ disorder/muscle pain with
dental sensitivity neurological signs, WBC abnormality movement, limited mouth opening
Local treatment No Specific dental treatment, Surgical Physical therapy, splints, anesthetic
LA to block pain injections
General treatment Anticonvulsant NSAIDS analgesics Chemotherapy, radio‑therapy, HSCT NSAIDS
Trigger Non noxious stimulus Food, cold, heat Jaw movement Palpation, jaw function
TMJ: Temporomandibular joint, WBC: White blood cell, NSAIDS: Non‑steroidal anti‑inflammatory drugs, HSCT: Hematopoietic stem cell transplantation,
LA: Local anesthesia

Journal of Advanced Clinical & Research Insights  ●  Vol. 2:1  ●  Jan-Feb 201513
Retrospective study of orofacial pain Shetty, et al.

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Figure 2: Classification of orofacial pain

0DOH

)HPDOH
Graph 2: Comparison of varied orofacial pain between male and
female group

Table 3: Various types of orofacial pain affecting the male and

female population
Total Female Female % Male Male %
Pulpitis 1060 637 49 423 47
Periodontal pain 661 364 28 297 33
Pericoronitis 259 169 13 90 10
Graph 1: Gender distribution of patients
TMD and neuralgia 110 65 5 45 5
Table 2: Causal distribution of orofacial pain Others 110 65 5 45 5
Type of orofacialpain Total Percentage TMD: Temporomandibular dysfunction
Pulpitis 946 43
Periodontal pain 704 32 Discussion
Pericoronitis 286 13
Various facets would collaborate within the human body to
TMJ disorder dysfunction and neuralgia 176 8 identify the onset of the disease, its pattern of progression,
Others 88 4 and the development of continuous pain. Disparate milieu like
TMJ: Temporomandibular joint various lifestyles, stress factors and gender, are also essential

14 Journal of Advanced Clinical & Research Insights  ●  Vol. 2:1  ●  Jan-Feb 2015
 Shetty, et al.
variables.[7] Our study conducted has shown an increase in
the number of females seeking treatment for orofacial pain,
by which we could suggest that females are more prone
to developing pain. Both male and female hormones may
contribute to gender-related discrepancies in the origin of
musculoskeletal pain.[8]
Conclusion
Higher prevalence of orofacial pain was witnessed among
the female patient group. Most prevalent reason for orofacial
pain in the subjects observed was pulpitis with 946 or 43% of
the patients. TMJ dysfunction, neuralgia and others-namely
neoplastic were the least observed. Multidisciplinary approaches
and a biopsychosocial model of pain management are an
essential adjunct to established evidence-based medical and
surgical management of these conditions.[9,10]
References
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2. Conti PC, Pertes RA, Heir GM, Nasri C, Cohen HV, Araújo Cdos R.
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3. Shephard MK, Macgregor EA, Zakrzewska JM. Orofacial pain:
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View publication stats
Retrospective study of orofacial pain
A guide for the headache physician. Headache 2014;54:22-39.
4. Benoliel R, Birman N, Eliav E, Sharav Y. The International
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How to cite this article: Shetty A, James L, Nagaraj T,
Abraham M. Epidemiology of orofacial pain: A retrospective
study. J Adv Clin Res Insights 2015;2:12-15.