Background & Aims
Orofacial pain (OFP) as well as non-painful temporomandibular disorders (np-TMD) represent a wide range of underlying conditions1–3. The complex symptomatology often makes the diagnostic process challenging. In many cases, it takes years before a diagnosis is made and targeted therapy can be started. Time to diagnosis (TTD) is defined as the interval from the onset of the first symptoms to the diagnosis of a disease in a patient 4. Diagnosis delay prolongs the patient’s suffering, favors the chronification and negatively affects the treatment prognosis5,6.
The aim of the study is to identify factors that have a potential influence on the diagnosis delay (TTD) in patients suffering from OFP or np-TMD.
Methods
We retrospectively evaluated the data of patients’ who visited the Orofacial Pain Unit at the Center of Dental Medicine, University of Zurich, Switzerland between 2017 and 2022. Patient characteristics such as demographic data, psychosocial factors (graded chronic pain scale: GCPS v2, depression: PHQ-9, anxiety: GAD-7, insomnia: ISI and pain catastrophizing: PCS), leading symptom, comorbidities, pain intensity on the numeric rating scale (0-10) as well as expertise of the referring specialist, time-point of the first consultation and the diagnosis itself were extracted. Descriptive statistics, correlations and multiple linear regression were calculated using SPSS version 28 (IBM).
This study was approved by the Ethics Committee of the State of Zurich, Switzerland and was performed in line with the principles of the Declaration of Helsinki.
Here we present the preliminary results of the on-going study (target sample size: 200).
Results
Data of 46 patients (34 f) were analysed. Mean age was 48y (SD 19.2y), mean TTD was 4.4 y (SD 7.6, min 1m, max 41.2y), mean (SD) average pain intensity was 4.9 (2.8). Half of the patients were referred from a dentist, followed by 7 referrals from general practitioners and 6 from ENT specialists. Median number of received OFP-diagnoses was 4. 34 patients had signs of awake or sleep bruxism. The mode diagnosis was myofascial pain (30 patients). One-third of the patients showed noticeable catastrophizing, PHQ-9 mode was 11 (moderate depression >10/27), GAD-7 mode was 11 (moderate anxiety 10/21), ISI mode was 13 (clinically relevant insomnia 14/28). There was a strong effect of PCS (r=.488) and GAD-7 (r=.746) on TTD.
The overall regression was statistically significant (R2=.894, F=19.947, p=.003). It was found that TTD could be significantly predicted by the number of diagnoses TTD (?=1.14), maximal pain intensity (?= .565), PHQ-9 (?=-.544) and GCPS-2 (? =.514).
Conclusions
Our preliminary results indicate that patients suffering from OFP or np-TMDs usually need to wait over 4 years for the diagnosis to be made. Furthermore, there is a considerable discrepancy in the TTD, some patients staying without a diagnosis for decades. Most of the patients received multiple OFP and/ or np-TMD diagnoses, pointing the complexity of the problem. Dentist referred by far the biggest share of the patients and the majority of the patients showed signs of bruxism. Particularly strong relationship between catastrophizing and anxiety and TTD was observed, however the causality of this effect cannot be determined due to the study design limitations. Number of diagnoses, maximal pain intensity, PHQ-9 and GCPS-2 were the main predictors for TTD.
References
1.Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache;28(1):6–27, 2014.
2.International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia;40(2):129–221, 2020.
3.Sessle BJ. Chronic Orofacial Pain: Models, Mechanisms, and Genetic and Related Environmental Influences. Int J Mol Sci;22(13), 2021.
4.Launay E, Cohen JF, Bossuyt PM, Buekens P, Deeks J, Dye T, et al. Reporting studies on time to diagnosis: proposal of a guideline by an international panel (REST). BMC Med;14(1):146, 2016.
5.Seo MR, Baek HL, Yoon HH, Ryu HJ, Choi H-J, Baek HJ, et al. Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol;34(8):1397–405, 2015.
6.Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health;11:770, 2011.
Presenting Author
Aleksandra Zumbrunn Wojczynska
Poster Authors
Aleksandra Zumbrunn Wojczynska
DMD
Univeristy of Zurich, Center of Dental Medicine
Lead Author
Ayushi Tiwari
Centre of Dental Medicine, University of Zurich, Switzerland
Lead Author
Diya Mundackal
Centre of Dental Medicine, University of Zurich, Switzerland
Lead Author
Mutlu Özcan
Prof. DDS
Centre of Dental Medicine, University of Zurich, Switzerland
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain