Pediatric Chronic Orofacial Pain: A Narrative Review of Biopsychosocial Associations and Treatment Approaches

Pediatric chronic orofacial pain (OFP) is an umbrella term which refers to pain associated with the hard and soft tissues of the head, face, and neck lasting >3 months in patients younger than 18 years of age. Common chronic pediatric OFP diagnoses include temporomandibular disorder, headaches, and neuropathic pain. Chronic OFP can adversely affect youth's daily functioning and development in many areas of well-being, and may be associated with emotional stress, depression, functional avoidance, and poor sleep, among other negative outcomes. In this mini-review, we will discuss common psychological comorbidities and familial factors that often accompany chronic pediatric OFP conditions. We will also discuss traditional management approaches for pediatric orofacial pain including education, occlusal appliances, and psychological treatments such as relaxation, mindfulness-based interventions, and cognitive-behavioral treatments. Finally, we highlight avenues for future research, as a better understanding of chronic OFP comorbidities in childhood has the potential to prevent long-term pain-related disability in adulthood.

Chronic Orofacial Pain and Systemic Disorders - A Prospective Study from Chennai, Tamil Nadu

BACKGROUND Orofacial pain conditions occur due to complex pathophysiology and are often associated with psychosocial comorbidities. The purpose of the study was to assess the association between orofacial pain and systemic disorders. METHODS The study was conducted in a university dental hospital setting covering patients visiting for the management of various orofacial pain conditions from October 2020 to February 2021. A total of 50 patients clinically diagnosed with chronic orofacial pain (> 3 months) were involved in the study. RESULTS In this prospective study, 50 orofacial pain patients were involved in the study and consisted of burning mouth syndrome [BMS (12 %)], orofacial neuralgia (26 %), temporomandibular disorder [TMDS (54 %)] and atypical facial pain (8 %). Chronic orofacial pain patients were more common in 21 - 30 years (30 %) with a female predilection (56 %). The most common systemic disorders were gastritis (28 %) followed by depression (17 %), diabetes mellitus (13 %). CONCLUSIONS Chronic orofacial pain has a significant impact on quality of life and daily functioning. Chronic orofacial pain is associated with systemic diseases like gastritis, depression and diabetes mellitus. A biopsychosocial approach for the diagnosis and management may address the multifactorial aetiology of orofacial pain conditions whilst limiting the economic and health-related burden. KEY WORDS Orofacial Pain, Neuropathic Pain, TMD, Gastritis, Depression, Diabetes

Assessment and Brain Training of Patients Experiencing Head and Facial Pain with a Distortion of Orofacial Somatorepresentation: A Narrative Review

The management of patients experiencing chronic orofacial pain is a great challenge, due to the complexity of chronic pain itself, combined with an increased peripheral sensitization in the craniofacial itself. Therefore, patients with orofacial pain may present a clear distortion of the somatorepresentation after some time. In this review, the authors develop a neurophysiological explanation of orofacial distortion, as well as propose assessment and treatment options, based on scarcely available scientific evidence and their own clinical experience. The assessments of facial somatosensory, cognitive-affective and motor dysfunctions are crucial to establish the most accurate treatment; the assessment tools are described in the article. Two-point discrimination, laterality recognition and emotion recognition are altered in patients with orofacial pain. Other sensorimotor assessment tools, such as motor acuity and auditory acuity, are also explained. Finally, the authors review their treatment proposals, based on the integration of brain training techniques and biobehavioral interventions. Somatosensory reintegration (tactile acuity training), facial emotion recognition, movement representation techniques, orofacial motor training and therapeutic patient education are explained in detail, and this may challenge new directions in rehabilitation and research.

Evaluation of the Quality of Life, and Prevalence of Chronic Orofacial Pain, in Patients with Diabetes in Kermanshah, Iran, in 2019

BACKGROUND This study intended to evaluate the prevalence of chronic orofacial pain in diabetic patients and its characteristics. METHODS In this cross-sectional study, 1300 patients referred to the Diabetes Centre of Taleghani Hospital in Kermanshah in 2019 were studied. The data collection tool was a questionnaire including demographic sections, medical history, and clinical findings. Data analysis was performed using SPSS software version 18, and the significance level was considered 0.05. RESULTS The prevalence of chronic orofacial pain in diabetics was 11.8 %. Headaches with a prevalence of 6.7 % were the most common chronic pain, followed by neuropathic pain with 2.54 % and TMJ pain with 2.38 %. The results showed that with an increase in FBS (Fasting Blood Sugar) and HbA1c (Haemoglobin A1c) variables, the prevalence of chronic orofacial pain also increased (P < 0.001). People under 40 and over 60 years were more likely to have TMJ pain (P < 0.001). Also, the duration of pain showed a statistically significant relationship with age and FBS. In patients under 50 years of age, the highest frequency was related to pain persistence less than 30 minutes, and in older ages, the prevalence of pain lasting more than 3 hours was higher (P < 0.02). Also, with an increase in FBS, the duration of pain increased (P < 0.05). The relationship between perceived pain intensity and type of diabetes was significant (P < 0.001). There was also a statistically significant and inverse relationship between pain intensity and age (P < 0.001, ρ = - 0.473). CONCLUSIONS Migraine headaches, chronic neuropathic pain, and TMJ complication have high prevalence in diabetic patients, and management of these pain should be put under consideration by clinicians. KEY WORDS Diabetes, Chronic Orofacial Pain, Prevalence

Chronic Orofacial Pain: Models, Mechanisms, and Genetic and Related Environmental Influences

Chronic orofacial pain conditions can be particularly difficult to diagnose and treat because of their complexity and limited understanding of the mechanisms underlying their aetiology and pathogenesis. Furthermore, there is considerable variability between individuals in their susceptibility to risk factors predisposing them to the development and maintenance of chronic pain as well as in their expression of chronic pain features such as allodynia, hyperalgesia and extraterritorial sensory spread. The variability suggests that genetic as well as environmental factors may contribute to the development and maintenance of chronic orofacial pain. This article reviews these features of chronic orofacial pain, and outlines findings from studies in animal models of the behavioural characteristics and underlying mechanisms related to the development and maintenance of chronic orofacial pain and trigeminal neuropathic pain in particular. The review also considers the role of environmental and especially genetic factors in these models, focussing on findings of differences between animal strains in the features and underlying mechanisms of chronic pain. These findings are not only relevant to understanding underlying mechanisms and the variability between patients in the development, expression and maintenance of chronic orofacial pain, but also underscore the importance for considering the strain of the animal to model and explore chronic orofacial pain processes.

THERMOGRAPHY – A REVIEW

Thermography is a technique of measurement of skin temperature distribution on the body over a given period of time. It is a noncontact, noninvasive method that utilizes the heat from an object to detect, display, and record thermal patterns and temperature across the surface of the object. Over the years, various devices have been used to measure the amount of heat dissipated by the body and most recently thermography has been emerged to detect the oral and maxillofacial pathologies. It is used to detect malignancies of the maxillofacial region such as vitality of teeth, TMJ disorders, chronic orofacial pain, assessing inferior alveolar nerve decit, and detection of herpes labialis. The present article highlights the history, basic principles, types and applications of thermography and its benecial role in detecting the maxillofacial pathologies in dentistry.