31: A Nationwide Survey Highlights Medical vs Dental Diagnostic Variability in Orofacial Pain.

Topic: Basic Science
Subtopic: Non-specific to any diagnosis (including studies in healthy animals), Developing methodology/technology

Background and Aims: Orofacial pain (OFP) is a common and debilitating condition encountered by both medical and dental clinicians. Overlapping features between odontogenic and non-odontogenic causes create diagnostic uncertainty, resulting in inconsistent management and poorer patient outcomes. Misdiagnosis may lead to unnecessary investigations, inappropriate treatment, increased healthcare costs, and psychosocial burden. Although classification systems exist, their chairside application remains complex and limited. Variability in training and clinical experience further contributes to delayed or inappropriate referral. Therefore, this study compares the perspectives and clinical practices of Malaysian medical and dental clinicians regarding OFP and evaluates the need for a structured, chairside-friendly diagnostic framework development.

Methods: A nationwide cross-sectional survey was distributed to clinicians from both dental and medical backgrounds across various hospitals, clinics, and academic institutions in Malaysia. This survey evaluated the demographic profile, clinical experience, diagnostic and treatment confidence, referral tendencies, consequences of misdiagnosis and familiarity with various OFP classification systems. Statistical analyses comparing groups (medical versus dental) were conducted and the associated risk factors in poor OFP management.

Results: A total of 387 clinicians participated, 78.29% from dental backgrounds and 21.71% from medical backgrounds. Diagnostic confidence was low to moderate, with more than half requiring multiple consultations and 52% referring patients to higher-level centres. Significant differences between groups were observed in patient volume (p=0.012), first-contact roles (p=0.016), analgesic prescription as primary therapy (p=0.006), diagnostic confidence (p=0.008), referral patterns (p=0.007), and familiarity with OFP classification systems (p<0.001). Most respondents recognised the consequences of misdiagnosis (93%) and supported further training (85.8%), with nearly 90% favouring a systematic diagnostic algorithm. Reliability analysis indicated good internal consistency (Cronbach’s alpha = 0.879).

Conclusions: Marked diagnostic variability exists between medical and dental clinicians in managing OFP. Developing a unified, systematic chairside diagnostic framework could standardise evaluation procedures, facilitate early differentiation of pain aetiology, optimise referral processes, and enhance multidisciplinary approaches to pain management. These findings support the development of cross-disciplinary chairside diagnostic tools that may improve patient outcomes in cases of OFP.

References: 1. International Headache Society. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020;40(2):129–221.
2. Ananthan S, Benoliel R. Chronic orofacial pain. J Neural Transm (Vienna). 2020;127(4):575–588.
3. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831–849.
4. Clark GT. Persistent orodental pain, atypical odontalgia, and phantom tooth pain: when are they neuropathic disorders? J Calif Dent Assoc. 2006;34(8):599–609.
5. Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15(10):1013–1028.
6. Dawson A, Raphael KG, Glaros A, Axelsson S, Arima T, Ernberg M, et al. Development of a quality-assessment tool for experimental bruxism studies: reliability and validity. J Orofac Pain. 2013;27(2):111–122.
7. De Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis, and management. Hanover Park (IL): Quintessence Publishing; 2018.
8. Farooqi OA, Bruhn WE, Lecholop MK, Velasquez-Plata D, Maloney JG, Rizwi S, et al. Opioid guidelines for common dental surgical procedures: a multidisciplinary panel consensus. Int J Oral Maxillofac Surg. 2020;49(3):397–402.
9. Ghurye S, McMillan R. Orofacial pain – an update on diagnosis and management. Br Dent J. 2017;223(9):639–647.
10. Hegarty AM, Zakrzewska JM. Differential diagnosis for orofacial pain, including sinusitis, TMD, trigeminal neuralgia. Dent Update. 2011;38(6):396–405.
11. Hossain MZ, Bakri MM, Yahya F, Ando H, Unno S, Kitagawa J. The role of transient receptor potential (TRP) channels in the transduction of dental pain. Int J Mol Sci. 2019;20(3).
12. Jaafar N, Saub R, Razak IA. The prevalence of orofacial pain and discomfort among 16-year-old students in Kelantan: a pilot study. Ann Dent Univ Malaya. 1997;4(1):9–12.
13. John MT, Sekulić S, Bekes K, Al-Harthy MH, Micheloj A, Reissmann DR, et al. Why patients visit dentists: a study in all World Health Organization regions. J Evid Based Dent Pract. 2020;20(3):101459.
14. Klasser GD, Goulet JP, De Laat A, Manfredini D. Classification of orofacial pain. In: Contemporary oral medicine. Cham: Springer; 2018. p.1–24.
15. Labanca M, Giano M, Franco C, Rezzani R. Orofacial pain and dentistry management: guidelines for a more comprehensive evidence-based approach. Diagnostics (Basel). 2023;13(17).
16. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc. 1993;124(10):115–121.
17. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Orofacial pain in the community: prevalence and associated impact. Community Dent Oral Epidemiol. 2002;30(1):52–60.
18. Malaysia Oral Health Programme. Annual report 2022. Malaysia: Ministry of Health; 2022.
19. Maulina T, Yubiliana G, Rachmi CN, Wulansari D, Rikmasari R. Prevalence of orofacial pain and its association with demographic factors in West Java Province, Indonesia. Int J Clin Dent. 2016;9(3).
20. McMillan AS, Wong MC, Zheng J, Luo Y, Lam CL. Widespread pain symptoms and psychological distress in southern Chinese with orofacial pain. J Oral Rehabil. 2010;37(1):2–10.
21. Merskey H. The taxonomy of pain. Med Clin North Am. 2007;91(1):13–20.
22. Meyer RA, Raja SN. Peripheral neural mechanisms of nociception. In: Wall PD, Melzack R, editors. Textbook of pain. 3rd ed. Edinburgh: Churchill Livingstone; 1995. p.13–44.
23. Mustafa NS, Kashmoola MA, Al-Ahmad BEM, Fansuri M, Jurimi NHM, Kashmoola S. Etiological factors of orofacial pain in a Malaysian sample. Eur J Dent. 2022;16(2):302–306.
24. Nijs J, Van Wilgen CP, Van Oosterwijck J, Van Ittersum M, Meeus M. How to explain central sensitisation to patients with unexplained chronic musculoskeletal pain: practice guidelines. Man Ther. 2011;16(5):413–418.
25. Pateman B. Computer-aided qualitative data analysis: the value of NUD*IST and other programs. London: Sage; 1998.
26. Pigg M, Nixdorf DR, Law AS, Renton T, Sharav Y, Baad-Hansen L, et al. New International Classification of Orofacial Pain: what is in it for endodontists? J Endod. 2021;47(3):345–357.
27. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982.
28. Renton T. Dental (odontogenic) pain. Rev Pain. 2011;5(1):2–7.
29. Splieth CH, Tachou A. Epidemiology of dentin hypersensitivity. Clin Oral Investig. 2013;17(Suppl 1):S3–8.
30. Wong MC, McMillan AS, Zheng J, Lam CL. The consequences of orofacial pain symptoms: a population-based study in Hong Kong. Community Dent Oral Epidemiol. 2008;36(5):417–424.
31. Yatani H, Komiyama O, Matsuka Y, Wajima K, Muraoka W, Ikawa M, et al. Systematic review and recommendations for nonodontogenic toothache. J Oral Rehabil. 2014;41(11):843–852.
32. Yusof Z, Mohamed N, Radzi Z, Yahya N, Ramli A, Abdul-Kadir R. The problems and impacts of orofacial pain among a group of Malaysian aborigines. Ann Dent Univ Malaya. 2007;14(1):31–38.

Presenting Author: DR. SOH JUN JUN
Submitting Author: JUN JUN SOH

Senior Author: DR. TAN HUANN LAN

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• DR. TAN HUANN LAN: BACHELOR OF DENTAL SURGERY - THE NATIONAL UNIVERSITY OF MALAYSIA
• DR. RIFQAH NORDIN: DOCTOR DENTAL SURGERY - THE NATIONAL UNIVERSITY OF MALAYSIA
• ASSOCIATE PROFESSOR DR. I. SOO M. A. SOO (EASON): DOCTOR DENTAL SURGERY - THE NATIONAL UNIVERSITY OF MALAYSIA
• PROFESSOR DR. KHOO SUAN PHAIK: BACHELOR OF DENTAL SURGERY - INTERNATIONAL MEDICAL UNIVERSITY
• DR. NORHAYATI BINTI OMAR: BACHELOR OF DENTAL SURGERY - HOSPITAL PUTRAJAYA
• ASSOCIATE PROFESSOR DR. SHAHIDA BINTI MOHD SAID: BACHELOR OF DENTAL SURGERY - THE NATIONAL UNIVERSITY OF MALAYSIA
• PROFESSOR DR. WEY MANG CHEK: BACHELOR OF DENTAL SURGERY - UNIVERSITY MALAYA
• ASSOCIATE PROFESSOR DR. NADIA BINTI MD NOR: THE BACHELOR OF MEDICINE AND BACHELOR OF SURGERY - THE NATIONAL UNIVERSITY OF MALAYSIA
• ASSOCIATE PROFESSOR DR. WAN ALIAA BINTI WAN SULAIMAN: THE BACHELOR OF MEDICINE AND BACHELOR OF SURGERY - UNIVERSITI PUTRA MALAYSIA
• DR. NUUR ASYIKIN BINTI MOHD SHUKOR: THE BACHELOR OF MEDICINE AND BACHELOR OF SURGERY - THE NATIONAL UNIVERSITY OF MALAYSIA
• PROFESSOR DR. MOHD ZULKIFLEE ABU BAKAR: THE BACHELOR OF MEDICINE AND BACHELOR OF SURGERY - UNIVERSITY MALAYA
• ASSOCIATE PROFESSOR DR. LIM GHEE SEONG: BACHELOR OF DENTAL SURGERY - UNIVERSITY MALAYA
• DR. JASWINDER SINGH MUKHWANT SINGH: DOCTOR DENTAL SURGERY - HOSPITAL SELAYANG
• ASSIT. PROFESSOR DR. LEE, ANGELINE HUI CHENG: BACHELOR OF DENTAL SURGERY - THE UNIVERSITY OF HONG KONG