The classification and differential diagnosis of orofacial pain
Department Oral Surgery, Kings College London Dental Institute, Denmark Hill Campus, Bessemer Road, London SE5 9RS, UK.Expert Review of Neurotherapeutics (Impact Factor: 2.78). 05/2012; 12(5):569-76. DOI: 10.1586/ern.12.40
There are currently four main pain classification systems relevant to orofacial pain (OFP): the International Association for the Study of Pain, International Classification of Headache Disorders, the American Academy of Orofacial Pain and the Research Diagnostic Criteria for Temporomandibular Disorders. Of the four, the Research Diagnostic Criteria for Temporomandibular Disorders is the most biopsychosocial system, with the remaining three focusing more on the biomedical aspects. Unsurprisingly, clinical scientists and clinicians have both reported perceived deficiencies in the published systems and have proposed further modified classifications and nomenclature for OFP. Establishing a standardized biopsychosocial classification of OFP is essential for ensuring continuity for patient care since it creates a standardized language with which to communicate healthcare information, thus enabling improved and more specific (epidemiological) research and patient care. Despite ongoing attempts, an accepted overarching classification of OFP is still a work in progress. There is an urgent need for a robust classification system for OFP. This review aims to highlight the recent debate and continued struggle to attain a consensus on a classification of OFP and highlight some recent developments that assist differential diagnosis of these conditions.
Article: Orofacial pain: A primer[Show abstract] [Hide abstract]
ABSTRACT: Orofacial pain refers to pain associated with the soft and hard tissues of the head, face, and neck. It is a common experience in the population that has profound sociologic effects and impact on quality of life. New scientific evidence is constantly providing insight into the cause and pathophysiology of orofacial pain including temporomandibular disorders, cranial neuralgias, persistent idiopathic facial pains, headache, and dental pain. An evidence-based approach to the management of orofacial pain is imperative for the general clinician. This article reviews the basics of pain epidemiology and neurophysiology and sets the stage for in-depth discussions of various painful conditions of the head and neck.Dental clinics of North America 07/2013; 57(3):383-92. DOI:10.1016/j.cden.2013.04.001
- The Korean journal of pain 10/2013; 26(4):407-8. DOI:10.3344/kjp.2013.26.4.407
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ABSTRACT: The aim of the present study was to evaluate the accuracy of the Fonseca anamnestic index (FAI) in the identification of myogenous temporomandibular disorder (TMD). Two hundred and three female volunteers participated in this study, 117 with myogenous TMD and 86 without TMD. The Research Diagnostic Criteria for Temporomandibular Disorders were first applied as the gold standard for the diagnosis. The volunteers then answered the 10 items on the FAI, which furnished a score ranging from 0 to 100 points. The receiver operating characteristic (ROC) was used to determine the accuracy of the diagnosis (area under the curve) and the best cutoff point of the tool. Thus, FAI demonstrated a high degree of accuracy for the diagnosis of myogenous TMD (area under the ROC curve of 0.940). The best cutoff point was a score of 47.50. Thus, a score ranging from 0 to 45 points corresponds to the absence of myogenous TMD and scores ranging from 50 to 100 points identifies individuals with the disorder. In conclusion, the high degree of diagnostic accuracy demonstrates that the FAI can be employed for the identification of myogenous TMD in female community cases. Copyright © 2014 Elsevier Ltd. All rights reserved.Journal of Bodywork and Movement Therapies 08/2014; 19(3). DOI:10.1016/j.jbmt.2014.08.001
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