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Psychological Factors in Oral Mucosal and Orofacial Pain Conditions

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Psychological Factors in Oral Mucosal and Orofacial Pain Conditions Published online: 2019-10-01 Review Article Psychological factors in oral mucosal and orofacial pain conditions Mohammad S. Alrashdan1, Mustafa Alkhader1 1Department of Oral Medicine and Oral Surgery, Correspondence: Dr. Mohammad S. Alrashdan Faculty of Dentistry, Jordan University of Science and Email: [email protected] Technology, Irbid, Jordan ABSTRACT The psychological aspects of chronic pain conditions represent a key component of the pain experience, and orofacial pain conditions are not an exception. In this review, we highlight how psychological factors affect some common oral mucosal and orofacial pain conditions (namely, oral lichen planus, recurrent aphthous stomatitis, burning mouth syndrome, and temporomandibular disorders) with emphasis on the significance of supplementing classical biomedical treatment modalities with appropriate psychological counseling to improve treatment outcomes in targeted patients. A literature search restricted to reports with highest relevance to the selected mucosal and orofacial pain conditions was carried out to retrieve data. Key words: Oral mucosa, orofacial pain, psychology, psychosocial INTRODUCTION and duration of his/her pain. The patient can describe the pain more accurately because the brain is better The International Association for the Study of able to localize and isolate it. However, as time Pain (IASP) has defined pain as “an unpleasant, progresses, this ability declines and expression of sensory, and emotional experience associated with the motivational/effective system begins to become actual or potential tissue damage, or described in more dominant in the pain experience, and so, the terms of such damage.”[1] This definition does not pain language used by patients changes to one that is only include the sensory aspect of pain but also the characterized more by psychological nondescriptive emotional and interpretive or cognitive aspects of terms.[2] Common symptoms reported by the pain. The IASP has also described chronic pain as pain chronic orofacial pain patients include headaches, lasting longer than 6 months.[2] The emotional factors depression, chronic fatigue, sleep disorders, decreased are more significant in chronic than in acute pain and productivity, feelings of inadequacy, low self‑esteem, assert a significant influence that has to be recognized withdrawal, and mood disorders.[3] and addressed in order for effective management of chronic pain conditions, including orofacial pain, to MATERIALS AND METHODS take place. Oral mucosal pathology and orofacial pain comprise During the first 6 months of pain, the discriminative the main two domains of oral and maxillofacial system dominates the motivational/effective system, allowing the patient to better comprehend the location This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the Access this article online author is credited and the new creations are licensed under the identical terms. Quick Response Code: For reprints contact: [email protected] Website: How to cite this article: Alrashdan MS, Alkhader M. Psychological www.eurjdent.com factors in oral mucosal and orofacial pain conditions. Eur J Dent 2017;11:548‑52. DOI: 10.4103/ejd.ejd_11_17 548 © 2017 European Journal of Dentistry | Published by Wolters Kluwer ‑ Medknow Alrashdan and Alkhader: Psychological factors in orofacial pain medicine. A literature review on individual has been well established.[1,2,5‑9] Psychopathological aspects within these two extensively broad areas disorders were even shown to be common among requires restrictions to be applied to the searched orofacial pain patients.[9] Furthermore, it has literature. Accordingly, to limit the scope of this been postulated that persistent orofacial pain as a review, oral mucosal lesions were limited to oral manifestation of psychological factors in the presence lichen planus (OLP) and recurrent aphthous or absence of organic pathology may become a source stomatitis (RAS) while orofacial pain conditions of significant personal distress and life disruption.[10] were limited to burning mouth syndrome (BMS) A recent report found that as the levels of pain‑related and temporomandibular joint disorders (TMD). disability increase, the perception of psychological Literature search was initially performed using influence on pain initiation and aggravation also MEDLINE/PubMed databases with different escalates.[11] combinations of “psychological factors,” “psychiatric factors,” “oral lichen planus,” “recurrent aphthous Biobehavioral is a term that integrates the important stomatitis,” “orofacial pain,” and “orofacial pain roles biological factors play in governing human classification” as key words. Exclusion criteria functioning with the influences of behavioral included articles on mucosal conditions or orofacial factors, including principles of learning, pain other than the aforementioned entries as interpersonal processes, and techniques for well as those published in languages other than self‑change.[5] Biobehavioral factors may promote English. No restrictions on articles types or dates or prolong physical dysfunction as well as thought of publication were applied. In addition, individual processes and emotions that may be distorted as a articles retrieved manually from the reference list of result of this dysfunction. the relevant papers were also included in the study. Thereafter, papers with the highest relevance to the These factors are as important to consider as the review topic were selected with the consideration of physical disease factors if the pain patient is to return the total number of references allowed. to normal functioning, especially in the case of chronic pain. PSYCHOLOGICAL ASPECTS OF PAIN PERCEPTION Accordingly, the biobehavioral model and cognitive behavior therapy (CBT) approaches were introduced Proper pain assessment, and subsequent management, to establish an effective and comprehensive should take into consideration both the somatosensory management of chronic pain conditions. input (nociception from the body tissues) and the Biobehavioral interventions are designed to address psychosocial input (influence from the higher centers). both excitatory factors for pain (e.g., expectations, Therefore, pain classification has been based on negative emotions, parafunctional behaviors) and two levels or axes.[4] Axis I represents the physical inhibitory factors (e.g., confidence, relaxation, factors that are responsible for the nociceptive input, positive emotion). These tools are designed to provide while Axis II represents the psychological factors patients with skills to understand and manage their that influence the pain experience. Chronic pains, pain experience.[5] as opposed to acute ones, often have significant Axis II factors. Psychological intensification of chronic When these approaches were applied in the pain may proceed until the suffering is wholly management of orofacial pain conditions, significant disproportionate to the peripheral nociceptive input positive results were reported, and hence, it was as in somatization. Pain may lack an adequate source recommended to utilize these approaches in such [12‑17] of input that is anatomically related to the site of pain, conditions. However, it appears that orofacial pain it may be felt in multiple and sometimes changeable management is still largely dependent on biomedical locations, bilateral pain may become evident in the interventions and is lacking proper implementation absence of bilateral sources of noxious input, and of psychological interventions.[18,19] the complaint may display unusual or unexpected responses to therapy which may further complicate OROFACIAL PAIN CLASSIFICATION the management.[3,4] A convenient classification of orofacial pain can be The significant impact of psychological factors on based on etiologic factors[20] and thus would include orofacial pain conditions, including mucosal lesions, • Dentoalveolar European Journal of Dentistry, Volume 11 / Issue 4 / October‑December 2017 549 Alrashdan and Alkhader: Psychological factors in orofacial pain • Dental – dentine sensitivity, cracked tooth, PSYCHOLOGICAL FACTORS IN COMMON pulpitis MUCOSAL CONDITIONS, ORAL LICHEN • Periodontal – periapical periodontitis, acute PLANUS, AND RECURRENT APHTHOUS necrotizing ulcerative • Gingivitis/periodontitis STOMATITIS • Mucosal disease • Ulcerative/erosive disorders including A relationship was postulated between psychological desquamative gingivitis factors and the occurrence and long‑term course of • Bony pathology some common oral mucosal conditions; namely OLP [6] • Alveolar osteitis (dry socket) and RAS. The two conditions are widely believed to be initiated and aggravated by many factors, • Osteomyelitis [21‑23] • Infected dental cyst including stress and anxiety. Hence, terms such • Osteonecrosis as psychosomatic diseases and stress‑related oral • Sinusitis ulcerations are frequently used in literature to refer to such conditions.[6,24] Likewise, oral mucosal conditions • Maxillary, paranasal, ethmoidal, and/or frontal are likely to cause significant levels of stress and • Salivary glands anxiety in affected individuals.[25] • Salivary duct calculi causing obstruction • Infective sialadenitis Several studies found higher levels of stress, anxiety, • Salivary gland tumor depression, and mental disturbance among OLP •
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