Management of Chronic Orofacial Pain: A Survey of General Dentists in German University Hospitals

Authors


  • Original Research Article

Stefan Wirz, MD, CURA Hospitals, Department for Anesthesiology, Interdisciplinary Intensive Care, Pain Therapy, Palliative Medicine, CURA-Hospitals, Schuelgen Str. 15, D-53604 Bad Honnef, Germany. Tel: +49 (0)2224 772-0; Fax: +49 (0)2224 772-1130; E-mail: stefan.wirz@cura.org; s.wirz@web.de.

Abstract

Aim.  This survey assessed procedures performed by general dentists in German university hospitals treating patients with chronic orofacial pain (COP).

Methods.  A standardized questionnaire was sent to dentists at all 42 German universities. Doctors were asked to describe demographics, diagnoses, etiologies, diagnostic, and treatment procedures for their patients seen over a 3-month period.

Results.  A total of 34,242 patients from 19 responding university hospitals were enrolled. COP of greater than 6 months duration was identified in 1,767 patients (5.2%), of whom 64% were female, 76% were between 20 and 59 years old, 66.3% frequently changed doctors, and 29.5% demonstrated psychological comorbidities. The most common causes of COP were temporomandibular disorders, atypical odontalgia, and atypical facial pain accounting for 83.4% of the sample, with purported etiologies of surgery or trauma (52.4%), musculoskeletal disorders (24.2%), prosthetics (11.4%), or psychosomatic causes (11.7%). A secondary pain syndrome was found in 25% of patients. Before admission to the universities, 59.4% of patients reported inadequate pain control. Following admission, the number of patients receiving specialized therapies significantly increased from 40.6% to 88.2% (χ2 test; P < 0.001), and improved pain was reported in 71.4% of patients. Multimodal therapy included treatment of malocclusion (47.1%), surgery (37.7%), analgesics (27.5%), and physiotherapy (22%). Specialized pain assessment (26.5%) or visual analog scales (16.9%) were applied irregularly and pain therapists were rarely consulted (8.9%). Despite the high psychological comorbidity (29.5%), psychological treatments were obtained for only 11%.

Conclusions.  The prevalence of COP is 5% in German University dental practices, where current guidelines of COP treatment are followed incompletely, and patients with psychological disorders are usually not treated. Interdisciplinary practice principles should be encouraged.

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