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The aim of the study was to determine the prevalence of patients suffering from chronic orofacial pain but did not respond to any conventional therapy and therefore were referred to the Department of Oral Medicine, Khyber College of Dentistry, Peshawar.

One hundred and eighty nine patients with overage age 39 years with persistent orofacial pain were recruited in this study. (135 females and 54 males).

The differential diagnosis was made on the basis of history, clinical examination and by applying the criteria laid down by International Association for the Diagnosis of Pain.

Analysis showed the following results; Patients suffering from tempo mandibular disorders (TMD) 72(38%), trigeminal neuralgia (TN) 45 (23%), burning mouth syndrome 24(12.6%), atypical facial pain 18(9.5%) Dental pain 15(7.9%), tension type headache 6(3.17%), oro pharyngeal tumors 9(4.7%).

After diagnosis the patients showed relief from pain when appropriate treatment was provided except nine patients which were suffering from tumor.

Key words: Chronic orofacial pain, causes, differential diagnosis, results


Orofacial pain effects the lives of millions of people around the world.1 It is a common clinical frustrating problem.2 The overlapping signs and symptoms3 and different sources of orofacial pain4,5,6 make its diagnosis very difficult.

Face is the most common area of referred pain from head and neck. Dental pain7 may radiate to the face.8,9 Chronic orofacial pain is classified into three basic categories: Somatic, neuropathic or psychogenic. Somatic pain results from noxious stimulation neural structures while neuropathic pain is caused by a structural abnormality in the nervous system. Psychogenic pain could be the cause when no physiologic or organic basis could be established (Table 1).


This retrospective study was conducted on patients suffering from chronic orofacial pain who did not respond to conventional treatment and were referred to the Department of Oral Medicine, Khyber College of Dentistry, Peshawar.

189 patients (135 females and 54 males) were analyzed during the period from November 2009 to November 2010. The study was approved by the ethic committee of the College. The inclusion criteria was patients suffering from orofacial pain of 3-6 months duration or more and were 17 years old and above. Only those patients who did not respond to prior treatment were included. The exclusion criteria was pregnancy and lactating mothers. The diagnosis was made on the basis of history and clinical examination and appropriate tests.

A specially designed proforma was prepared and got filled from each patient with his/her consent. Duration of pain, characteristics, sites, referral, initiating factors and relieving factors, previous consultations and treatment received were noted.

Radiographic Investigation was done in each case. Suspected oral cancer patients were biopsied. Criteria laid down by International Association for the Study of Pain was also kept in view.


Total of 189 patients who suffered from chronic orofacial pain formed the study group. These were 135 (71.5%) females and 54 (28.5%) males (Table 2). Female: Male ratio was 5:2 and age range of 17-70 years (mean 39 years). Prevalence of chronic orofacial pain in various groups is shown in (Table 3).


1. Local Causes a. Dental

b. Salivary glands

c. Sinus and Pharynx d. TMJ disorders

e. Ears/Eyes

2. Naeurological Causes

a. Trigeminal Neuralgias b. Malignent Neoplasms

c. Glossophryngeal Neuralgias

d. Herpes zoster (Including post herpetic neuralgia

3. Vascular Disorders

a. Migraine Neuralgia b. Giant cell artertis

4. Referred Pain a. Angina

b. Nasopharyngeal disease c. Ocular and Aural

d. Chest diseases (rare)

5. Psychogenic Causes

a. Atypical facial pain






Primary diagnosis n=189


###n = 54###n = 135

1 TMD###18###54

2 TN###15###30

3 BMS###6###18


5###Dental 3###12

6###Cancer 6###3

7 Tension



Orofacial pain is a very common complaint seen in general dental practice and the most common is dental origin.11,12 However, musculoskeletal pain was the most prevalent orofacial pain (TMD group) in this study. Gender and origin of various categories of pain determined in this study are listed in Tables 2, 3.

The tension type headache prevalence in females was 62.1% in a study conducted by M Prencipe et al17 but in that study 100% patient were female.

The incidence of trigeminal neuralgia was more in the study conducted at Netherlands17 as compared to the present study. In Netherland study 23% of total patients suffered from TN. In the present study females were 72% and males 28% whereas in the study conducted at King Saud University College of Dentistry,14 62.7% were females and 37.3% males and in a Scandivian study16 there were 52.5% males and 47.7% females patients.

The BMS and AFP occurrence in females is in accordance with other studies. However, the dental causes of orofacial pain were very low (3.9% ) in the present study.

The BMS and AFP occurrence in females is in accordance with other studies. However, the dental causes of orofacial pain were very low (3.9% ) in the present study.


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Article Details
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Author:Qazi, Javed A.; Khan, Misri; Qazi, Abdul Haseeb
Publication:Pakistan Oral and Dental Journal
Article Type:Clinical report
Geographic Code:9PAKI
Date:Dec 31, 2011

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