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Orofacial pain represents a significant burden in terms of morbidity and health service utilization. It includes very common disorders such as toothache and temporomandibular disorders, as well as rare orofacial pain syndromes. Many orofacial pain conditions have overlapping presentations, and diagnostic uncertainty is frequently encountered in clinical practice. This review provides a clinically orientated overview of common and uncommon orofacial pain presentations and diagnoses, with an emphasis on conditions that may be unfamiliar to the headache physician. A holistic approach to orofacial pain management is important, and the social, cultural, psychological and cognitive context of each patient needs to be considered in the process of diagnostic formulation, as well as in the development of a pain management plan according to the biopsychosocial model. Recognition of psychological comorbidities will assist in diagnosis and management planning.

Objectives: To validate the Hospital Anxiety and Depression Scale (HADS) and the 10-item Perceived Stress Scale (PSS-10) for use in patients with oral lichen planus (OLP) and to provide cross-sectional analysis of anxiety, depressive and distress symptoms in patients with OLP.Methods: Validity and reliability of both instruments were assessed in 260 participants with OLP in one tertiary Oral Medicine Centre through confirmatory factor analysis and calculation of reliability coefficients. Prevalence, Clinical and demographic predictors of the presence of psychological symptoms in OLP were calculated and identified using multivariated logistic regression.Results: Factor analysis results demonstrated that a bifactor model described the underlying structure of both scales better than other models. Values of omega indicated adequate reliability of total HADS and PSS-10 score while low coefficient omega hierarchical values limit clinical applicability of their subscale scores. The prevalence of anxiety, depressive and distress symptoms in OLP were 39.23%, 20.77% and 27.69% respectively. Pain intensity, disease comorbidities, age, smoking and alcohol consumption were found to be independent predictors of the presence of psychological symptoms in OLP. Conclusion:The HADS and PSS-10 are appropriate to use as general measures of psychological distress and perceived stress in patients with OLP.

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Background:The adoption of the Chronic Oral Mucosal Disease Questionnaire (COMDQ) into clinical practice has been low, despite its rigorous development process. A potential limitation of the COMDQ is the high response burden to patients. Therefore, the aim of the present study was to develop and validate a short version of the 26-item COMDQ. Methods:The COMDQ data of 520 patients with chronic oral mucosal diseases were randomly divided into 2 subsamples. Descriptive item analysis and exploratory factor analysis (EFA) were performed using data from the first subsample for item reduction and development of the shortened COMDQ. The resulting short version was then validated using confirmatory factor analysis (CFA) on the other subsample. Internal consistency reliability of the short-form COMDQ was assessed using Cronbach's alpha. Criterion validity of this new scale was examined against its original version. Results:Based upon item analysis, 11 items were dropped. EFA results on the remaining 15 items extracted 4 factors consistent with the original COMDQ, and CFA results displayed acceptable goodness-of-fit indices of this factor structure on different sample. The COMDQ-15 was then created. Cronbach's alpha of 4 subscale scores ranged from 0.7 to 0.91, indicating good internal consistency reliability of the COMDQ-15.Correlations between total and subscale scores of the COMDQ-15 and its parent scale were high, supporting good criterion validity of this shortened scale. Conclusion:The COMDQ-15 is a brief, valid and reliable instrument that can give an overview of the patient's quality of life related to their chronic oral mucosal conditions.

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Objectives To evaluate the responsiveness of measures of pain and oral health‐related quality of life (OH‐QoL) in patients with oral lichen planus (OLP) and to determine thresholds for minimal important change (MIC) and minimal important difference (MID) for use in this patient population. Methods Data from baseline and 4‐month follow‐up including Visual Analog Scale (VAS), Numerical Rating Scale (NRS), 14‐item Oral Health Impact Profile (OHIP‐14), 15‐item and 26‐item Chronic Oral Mucosal Disease Questionnaire (COMDQ‐15; COMDQ‐26) were collected from 157 patients with OLP. Responsiveness was assessed by testing hypotheses and calculating the area under the curve. MIC and MID were established based on triangulation of distribution‐based and anchor‐based estimates. Results The results supported adequate responsiveness of VAS, NRS, COMDQ‐15 and COMDQ‐26 for use in OLP, while the OHIP‐14 demonstrated relatively low sensitivity to detect improvement in the OLP status. Recommended meaningful improvement thresholds were as follows: VAS (MIC 16 mm; MID 18 mm), NRS (MIC/MID 2 points), OHIP‐14 (MIC/MID 5 points), COMDQ‐15 (MIC 5 points; MID 6 points) and COMDQ‐26 (MIC/MID 9 points). Conclusion This study provides some evidence of responsiveness as well as establishing meaningful improvement thresholds in scores of pain and OH‐QoL measures in OLP.

Objectives To validate the Hospital Anxiety and Depression Scale (HADS) and the 10‐item Perceived Stress Scale (PSS‐10) for use in clinical studies of recurrent aphthous stomatitis (RAS) and to provide cross‐sectional assessment of anxiety, depressive, and distress symptoms and perceived stress in patients with RAS. Methods The validity and reliability of the HADS and PSS‐10 were evaluated in 120 individuals with RAS through confirmatory factor analysis and calculation of Cronbach's alpha and omega coefficients. The prevalence of comorbid anxiety, depression, distress, and moderate‐to‐high perceived stress, and their association with demographics and clinical factors were assessed through cutoff scores of the HADS and PSS‐10 and bivariate analyses, respectively. Results A bi‐factor model, with all items loading onto general factor with two group factors, provides the best fit to the HADS and PSS‐10 data of this RAS cohort. While omega values suggested adequate reliability of total score of both scales, relatively low ranges of coefficient omega hierarchical limit utility of their subscale scores. The prevalence of anxiety, depression, distress, and moderate‐to‐high perceived stress was 42.5%, 18.33%, 28.33%, and 71.67%, respectively. Ethnicity, alcohol consumption, disease comorbidities, clinical type of RAS, ulcer size, pain, and RAS disease activity were found to be associated with negative psychological symptoms. Conclusion The HADS and PSS‐10 are valid and reliable as general scales of psychological distress and stress in patients with RAS. Significant mental burden among RAS patients makes the use of these validated instruments a sensible and prudent practice for psychological assessment of this patient group.