Are reports of mechanical dysfunction in chronic oro-facial pain related to somatisation? A population based study

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Are reports of mechanical dysfunction in chronic oro-facial pain related to somatisation? A population based study
European Journal of Pain, In Press, Corrected Proof, Available online 4 October 2007
Vishal R. Aggarwal, b, John McBeth, b, Joanna M. Zakrzewska, c, Mark Lunt, b and Gary J. Macfarlane, a
a-Aberdeen Pain Research Collaboration (Epidemiology Group), School of Medicine, University of Aberdeen, Aberdeen, United Kingdom
b-Arthritis Research Campaign Epidemiology Unit, Division of Epidemiology and Health Sciences, University of Manchester, Manchester, United Kingdom
c-Barts and the London, Queen MaryĚs School of Medicine and Dentistry, London, United Kingdom
Received 7 February 2007; revised 10 July 2007; accepted 5 August 2007. Available online 4 October 2007.

Abstract
Objectives
(i) To examine the association between self-reported mechanical factors and chronic oro-facial pain.
(ii) To test the hypothesis that this relationship could be explained by (a) reporting of psychological factors (b) common association of self-reported mechanical factors with other unexplained syndromes.

Methods
A population based cross-sectional study of 4200 randomly selected adults registered with a General Medical Practice in North West, England. The study examined the association of chronic oro-facial pain with a variety of self-reported mechanical factors: teeth grinding, facial trauma, missing teeth and the feeling that the teeth did not fit together properly. Information was also collected on demographic factors, psychological factors and the reporting of other frequently unexplained syndromes.

Results
An adjusted response rate of 72% was achieved. Only two mechanical factors: teeth grinding (odds ratio (OR) 2.0, 95% CI 1.3Ň3.0) and facial trauma (OR 2.0; 95% CI 1.3Ň2.9) were independently associated with chronic oro-facial pain after adjusting for psychological factors. However, these factors were also commonly associated with the reporting of other frequently unexplained syndromes: teeth grinding (odds ratio (OR) 1.8, 95% CI 1.5Ň2.2), facial trauma (OR 2.1; 95% CI 1.7Ň2.6).

Conclusions
Self-reported mechanical factors associated with chronic oro-facial pain are confounded, in part, by psychological factors and are equally common across other frequently unexplained syndromes. They may represent another feature of somatisation. Therefore the use of extensive invasive therapy such as occlusal adjustments and surgery to change mechanical factors may not be justified in many cases.

Keywords: Chronic; Oro-facial pain; Somatisation; Mechanical factors; Epidemiology

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