Management of chronic orofacial pain: a survey of general dentists in german university hospitals.
OBJECTIVE
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% (chi(2) 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.
Wirz
Stefan
S
CURA Hospitals, Department for Anesthesiology, Interdisciplinary Intensive Care, Pain Therapy, Palliative Medicine, CURA-Hospitals, Bad Honnef, Germany. stefan.wirz@cura.org
Ellerkmann
Richard K
RK
Buecheler
Marcus
M
Putensen
Christian
C
Nadstawek
Joachim
J
Wartenberg
Hans-Christian
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D015897:Comorbidity; D003815:Dentists; D005157:Facial Pain / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult