Web-based Survey of Different Dental and Medical Practitioners on Oro-facial Pain Conditions

The management of orofacial pain is of significance to the medical and dental professions. Dentists are most likely to face this situation, because persistent and chronic pain is more common in the head and neck region than in any other part of the body. The complexities involved in diagnosing neuropathic pain present a challenge for the treating clinician. These conditions are of importance in clinical dentistry as sometimes they can be misdiagnosed as an odontogenic pain leading to unnecessary irreversible treatment including endodontic treatment and sometimes extraction. The hypothesis that there will be greater than 60% agreement in diagnostic terminology among clinicians dealing with atypical facial pain (AFP), trigeminal neuralgia (TN) and atypical odontalgia (AO) was tested. The aim of this study was to compare the views of dental and medical clinicians who deal with atypical facial pain, trigeminal neuralgia and atypical odontalgia about the terminology, diagnostic tools and treatment approach. Electronic questionnaires with three hypothetical orofacial pain scenarios were sent to 100 healthcare professionals in each of the following groups: general dentist, endodontists, oral medicine specialists, neurologists and otolaryngologists. The e-mail addresses were collected from doctor’s contact information available in the public domain over the internet. A subscription service of Qualtrics was used for the electronic survey and the data collected was analyzed using statistical software SPSS 19. The clinicians were presented with hypothetical cases atypical facial pain (AFP), trigeminal neuralgia (TN) and atypical odontalgia (AO). The result of this study highlights inter-clinician variability in diagnosis and treatment among clinicians dealing with AFP, TN and AO. An interesting observation in the case scenario of AO was the majority of respondents chose the diagnostic terminology of AFP, although AO is an established independent clinical entity. Overall, the study also draws attention to the need for education of orofacial pain conditions both at undergraduate and postgraduate level of medical and dental education. Patients with neuropathic pain conditions often benefit from treatment which includes both medical and dental clinicians and an interdisciplinary approach. Endodontists, orofacial pain dentists, general dentists, specialists in oral medicine, neurologists and otolaryngologists are all likely to deal with the diagnosis and management of orofacial pain conditions and a consensus in diagnostic terminology and uniformity in management is recommended.