Perceived orofacial pain and its associations with reported bruxism and insomnia symptoms in media personnel with or without irregular shift work

A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular 8-hour daytime work. The aims were to investigate the prevalence and severity of perceived orofacial pain (Research Diagnostic Criteria for Temporomandibular Disorders Axis II) and to analyze whether current orofacial pain was associated with reported bruxism and insomnia symptoms (Diagnostic and Statistical Manual of Mental Disorders-IV and the International Classification of Sleep Disorders Revised). The response rate in the irregular shift-work group was 82.3% (56.6% men) and in the regular daytime-work group 34.3% (46.7% men). Current orofacial pain was found overall in 19.6%, of which 88.3% had experienced the pain over 6 months. All claimed that their pain fluctuated. No subjects with chronic orofacial pain reported disabling pain, and grades III and IV were not found. Insomnia symptoms and frequent bruxism were significantly more prevalent in chronic pain grade II than in lower grades. According to logistic regression, current orofacial pain was significantly positively associated with frequent bruxism (p < 0.001), female gender (p < 0.001), and disrupted sleep (p < 0.01), and significantly negatively associated with age over 45 years (p < 0.01). Our results revealed a clear-cut association between perceived orofacial pain and reported bruxism. The association held with both chronic orofacial pain intensity and current pain. Based on the multivariate analyses, it can be concluded that disrupted sleep and bruxism may be concomitantly involved in the development of orofacial pain.     

Broad support evident for the emerging specialty of orofacial pain

The emerging field of Orofacial Pain is being considered by the American Dental Association for full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited leaving many patients to continue to suffer. Subsequently, recent efforts to improve this by developing the field into a specialty have shown broad support among dentists and increased awareness of the benefits this field can provide for dentists and their patients. A recent survey of 805 individuals in the general population who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control-despite having the pain for more than 5 years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, President of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." (1). Development of the field of Orofacial Pain into a dental specialty has been motivated primarily by this issue; patients with complex chronic orofacial pain disorders have not been historically treated well by any discipline of health care. Recent studies of chronic orofacial pain patients have found that these patients have a high number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (2) (Fig. 1). Complex pain patients and the clinicians who see them are often confused about whom they should consult for relief of the painful disorder. Treatment for these patients within the existing structure of dental or medical specialties has been inadequate and millions of patients are left suffering. Insurers are also confused with regard to reimbursement and make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, Dentistry has taken a leading role in health care to address this national problem by developing the field of Orofacial Pain into a dental specialty. A study of dentists and dental specialists have shown that there is a recognized need and broad support for further development of this field into a new dental specialty(3).     

Musculoskeletal orofacial pain and other signs and symptoms of temporomandibular disorders during pregnancy: a prospective study

AIMS: To describe the course of reported musculoskeletal pain in the temporomandibular region and other signs and symptoms of temporomandibular disorders (TMD) as well as psychological distress over the course of pregnancy and 1 year postpartum. METHODS: Women with musculoskeletal orofacial pain (n = 19) and pain-free comparison subjects (n = 16) in the first trimester of pregnancy were selected through records review from the population of a large health maintenance organization. Subjects completed a self-administered questionnaire assessing pain, depression, and somatic symptoms; provided a sample of whole unstimulated saliva; and underwent a standardized clinical examination during the third, sixth, and ninth months of pregnancy and 1 year postpartum. RESULTS: At baseline (third month of pregnancy), 16 of the 19 patients with musculoskeletal orofacial pain met criteria for an RDC/TMD diagnosis. Reported musculoskeletal orofacial pain diminished significantly during the second or third trimester of pregnancy and increased again postpartum. Measures of mandibular opening increased over pregnancy in both cases and comparison subjects and remained high postpartum. Depression and somatic symptoms changed little over the course of pregnancy but were substantially lowered at 1 year postpartum for both groups. As expected, subjects with pain had higher levels of palpation pain, diminished mandibular range of motion, and higher levels of psychological distress compared to subjects without orofacial pain. CONCLUSION: Musculoskeletal orofacial pain and related symptoms appear to improve over the course of pregnancy. This improvement occurs in the presence of increased joint laxity and is not paralleled by improvements in psychological distress. Thus, it was concluded that the improvement in pain is most likely associated with the dramatic hormonal changes occurring during pregnancy.     

Orofacial pain emerging as a dental specialty

The emerging field of orofacial pain was considered by the American Dental Association for full status as a new dental specialty. While the recognition of orofacial pain as a specialty was denied, the American Academy of Orofacial Pain plans to continue its efforts. Many recent advances in the neuroscience of orofacial pain have led to treatments that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited, leaving many patients to suffer. Dentists are generally supportive of the efforts to develop oral pain treatment into a specialty because the field will provide benefits for both dentists and their patients. A recent survey of 805 individuals who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control--despite having the pain for more than five years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, president of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." Development of the field of orofacial pain into a dental specialty has been moved primarily by the fact that historically, patients with complex chronic orofacial pain disorders have not been treated well by any discipline of healthcare. Recent studies of chronic orofacial pain patients have found that these patients have a higher number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (see Figure 1). Complex pain patients and the clinicians who see them are often confused about who they should consult for relief of the pain. Treatment for those patients within the existing structure of dental or medical specialties has been inadequate, with millions of patients left suffering. Insurers are also confused with regard to reimbursement and may make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, dentistry has taken a leading role in healthcare to address the national problem of developing the field of orofacial pain into a dental specialty. A study of dentists and dental specialists has shown that there is a recognized need and broad support for developing this field into a specialty.     

Pain-related worry in patients with chronic orofacial pain

BackgroundPain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables.MethodsThe authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants’ answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain.ResultsThe authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference.ConclusionsParticipants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly.Practical ImplicationsClinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.     

Chronic orofacial pain; atypical facial pain?

Difficult to diagnose pain in the orofacial area may be a challenge to the dental practitioner. There still is uncertainty about the taxonomy of chronic orofacial pain, and even more so about its etiology. Treatment of chronic orofacial pain may aim at goals which are set in advance, but also at the underlying pain mechanisms. The disentanglement of pain into different pain mechanisms may be facilitated by applying a pharmacodiagnostic test. This test consists of intravenously administering several medications in low doses in orofacial pain patients. The response to the administration of these pharmaca is reported by means of a visual analogue scale (VAS) for pain. The profile, resulting from the consecutive VAS-scores, may be used as a guide for further treatment. Before the start of any treatment, the dentist should judge whether he himself is able to treat the patient or referral to a specialist is required.     

Prevalence of Various Orofacial Pain Symptoms and Their Overall Impact on Quality of Life in a Tertiary Care Hospital in India

Background

Pain is a major public health problem and is the most commonly reported symptom of oral and dental disease that has a significant impact on both individual and community. The present study was prevalence of various orofacial pain symptoms and their overall impact on the quality of life in a tertiary care hospital.

Materials and Methods

This study was carried out in the outpatient department of the Government Dental College and Research Institute, Bangalore. The severity of the chronic orofacial pain symptoms was assessed using the Chronic Pain Grade Questionnaire by Von Korff.

Results

The results showed that toothache (57.6 %) was the most commonly reported symptom and burning mouth sensation (6.4 %) was the least commonly reported. Majority of the patients had grade 3 level of pain-related disability (34.8 %) followed by grade 2 (26.8 %), grade 1 (22.4 %) and grade 4 levels (16 %). The mean pain intensity was reported to be more among females and maximum among patients with facial pain.

Conclusion

The present study demonstrated that orofacial pain symptoms have a significant impact on the patients suffering from it. Therefore, proper measures should be taken for the management of the patients with these symptoms and associated conditions.     

Referred Orofacial Pain as an Initial Symptom of Distant,Nonmetastatic Cancer: Report of a Case and Review of the Literature

Referred orofacial pain as the first symptom of an otherwise silent distant, nonmetastatic cancer has been reported, but there is sparse literature on the subject. Referred pain may not be considered in the orofacial pain differential diagnosis because of its rarity; however, this may delay a cancer diagnosis. The authors present a case report and a review of the English literature. Peer-reviewed publications were identified through a systematic search of MEDLINE, Embase, and Cochrane CENTRAL. Historic cases were reviewed, and available data regarding demographics, pain characteristics, treatment, cancer diagnosis, and outcome were extracted. Thirty-seven cases were identified. All cancers were intrathoracic. The average age was 54.1 years with a slight female predominance (3:2). Common pain characteristics were (1) diffuse location affecting the ear (76%), jaw (46%), and temple (30%); (2) constant duration (65%); (3) aching quality (74%); (4) severe intensity (94%); and (5) associated systemic symptoms (68%) such as weight loss and digital clubbing. The average time from the onset of facial pain to seeking medical attention was 9 months, and the average time from seeking medication attention to cancer diagnosis was 8 months. Orofacial pain was often attributed to odontogenic (35%) or neuropathic (25%) causes, and treatments for these conditions were also common. The impact of referred orofacial pain on the cancer prognosis was not possible because of the nature of the reviewed studies (case reports with no comparison group). Cancer-associated referred orofacial pain as a first symptom is rare but should be considered in cases with intractable pain and associated systemic symptoms.     

Chronic orofacial pain. Understanding patients from two perspectives: the clinical view and the patient's experience

The aim of this thesis was to study chronic orofacial pain patients from two perspectives--the clinical view and the experience of the patient--in order to improve the understanding of the patients and their condition. All patients had been referred to the Faculty of Odontology, Malm? University, Malm?, Sweden owing to chronic orofacial pain. The clinical perspective was investigated in a retrospective study of 109 consecutive chronic orofacial pain patients (85 females, 24 males) who had been examined by a pain group. Diagnosis, pain status, medication, and education were the parameters studied and pain-related sex differences were calculated. In addition, the patients were mailed a questionnaire after 4-9 years to follow up their pain status and to identify predictors of pain persistence. The patient perspective was investigated by interviewing 14 strategically selected patients (11 female, 3 male) about their lived experience of non-specific chronic orofacial pain. The interviews were of 1-1.5-hour duration and were conducted twice with each patient. The findings from the clinical studies and the interview studies are listed below. The experiences of the interviewed patients revealed additional aspects of several of the findings made in the clinical studies. The majority of the patients were female. Mainly similarities between the sexes were found regarding pain status and the other parameters studied. The patients had a lower level of education than Swedish inhabitants of the same ages. The majority of the patients in the clinical studies reported seeking care repeatedly owing to orofacial pain. The patients in the interview studies experienced distrust and rejection at the consultations for the orofacial pain. They also experienced the pain as elusive and difficult to communicate. Most of the patients in the clinical studies had persistent pain of some intensity at the follow-up 4-9 years later. The interviewed patients expressed a great need to be taken care of and often seemed to have a limited ability to cope with the pain. Among the patients studied clinically, a reported consumption of pharmacological agents with a central effect (opioids, muscle relaxants, antidepressants, neuroleptics, hypnotics, or sedatives) was a predictor of pain persisting at the follow-up. The interviewed patients expressed feelings of hopelessness and a lack of faith in the future. To study patients with chronic orofacial pain from a clinical viewpoint and from a patient perspective led to a deeper understanding of chronic orofacial pain as a complex condition that has an impact on every aspect of the patient's life. The patients often seek dental care because of the pain. It seems to be important in dentistry to develop constructive strategies for caring for these patients--especially when the dental disease condition has already been adequately diagnosed and treated, but the patients still experience pain.     

Oral and maxillofacial surgery in patients with chronic orofacial pain.

PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. Patients and Methods: The study population included patients seen at the Center for Oral, Facial and Head Pain at New York Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.     

The consequences of orofacial pain symptoms: a population-based study in Hong Kong

Objectives: To investigate the impacts associated with orofacial pain symptoms among adult Chinese people in Hong Kong. Associations between impacts, pain characteristics and professional treatment seeking behaviour were explored. Methods: A cross‐sectional, population‐based study was conducted using a telephone survey method. A sample of Cantonese‐speaking Chinese people aged 18 years and over living in Hong Kong was interviewed. The questionnaire incorporated questions on recent orofacial pain experience and characteristics. Respondents with orofacial pain symptoms were asked about the consequences of the pain on various aspects of daily life and whether they had sought treatment for the pain. Results: Of the 1222 survey respondents, 41.6% reported some form of orofacial pain. 79.3% of those who reported orofacial pain and about one‐third of the total sample had experienced at least one impact. The most common impact was worried about oral and dental health (59.8%) followed by avoided certain food (50.4%). Respondents with toothache were found to be more likely to have experienced all the impacts investigated (OR range: 2.048–3.309). People who had stayed in bed more than usual (OR = 2.342), experienced sleep disturbance (OR = 2.149), and worried about their oral and dental health (OR = 2.851) were more likely to seek professional treatment. Conclusions: The adverse impact of orofacial pain on the well‐being of the adult population of Hong Kong was substantial. Despite this, treatment seeking was low with a high level of untreated orofacial pain symptoms.     

The differential diagnosis of toothache from other orofacial pains in clinical practice

Background : Teeth are a common and obvious source of orofacial pain. There is a risk that endodontic treatment may be initiated in patients that do not have pulp or periapical pathosis.
Methods : A retrospective survey of a sample of patients referred for endodontic treatment was analysed to determine the accuracy of the diagnosis and to identify non-dental cases. A separate prospective study of complex non-dental orofacial pain cases was performed to determine which cases had previously received dental treatment.
Results : Seventy-seven (88 per cent) of 88 patients referred for endodontic treatment had been correctly diagnosed with solely endodontic problems. Eight (9 per cent) had endodontic plus other orofacial pain problems and three (3 per cent) had no endodontic problems but other orofacial pain problems. Forty-four (44 per cent) of 100 non-dental orofacial pain patients had previously received either extractions or endodontics.
Conclusion : Dentists need to carefully evaluate all toothache patients to ensure that the diagnosis is correct prior to the initiation of irreversible treatment.     

Pain-related impairment and health care utilization in children and adolescents: a comparison of orofacial pain with abdominal pain, back pain, and headache.

OBJECTIVE: The purpose was to compare orofacial (temporomandibular) pain with other pain complaints regarding impairment and health care utilization in a sample of 1,011 children and adolescents from a metropolitan area in Germany. METHOD AND MATERIALS: Individuals aged 10 to 18 years were sampled in schools using a 2-stage cluster technique. Orofacial pain in the previous month was assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Additionally, participants were questioned about headache, back pain, abdominal pain, pain-related impairment, and health care utilization (visits to doctors, analgesic consumption) in the previous month. RESULTS: Headache was reported by 50% (95% CI: 45% to 56%) of participants, stomach pain by 36% (95% CI: 32% to 41%), back pain by 31% (95% CI: 25% to 36%), and orofacial pain by 15% (95% CI: 12% to 18%). Girls were more affected than boys. The range of "severe" and "very severe" impairment lay between 8% (orofacial pain) and 22% (headache). The range of treatment demand was between 10% and 17% (orofacial pain: 15%), and the range for analgesic consumption between 18% and 24% (orofacial pain: 22%). The more pain experienced, the more impairment, doctor consultations, and analgesic consumption were reported (Chi2test: P < 0.05). Risk of orofacial pain was 60% higher for subjects with head, back, and/or abdominal pain (odds ratio: 1.6; 95% CI: 1.3 to 1.9). CONCLUSION: In children and adolescents, orofacial pain occurs about half as often as other pain complaints. However, relative to their prevalence the different pain complaints are similar regarding impairment and health care utilization.     

Development and validation of the Manchester orofacial pain disability scale

OBJECTIVE: To design and validate a self-administered instrument for assessing orofacial pain related disability in the general population. METHODS: The 32-item questionnaire was developed by open-ended interviews with patients attending dental hospital clinics and was subsequently tested on 171 community subjects with self-reported orofacial pain and 48 dental hospital patients. RESULTS: Construct validity of the instrument was demonstrated in three ways. First, levels of reported disability were greater in dental hospital patients than for community subjects reporting orofacial pain. Secondly, the instrument was able to detect differences in disability levels reported by community subjects who did and did not consult with a healthcare professional and those who had acute and chronic pain. Thirdly, amongst community subjects with pain, disability scores increased with higher pain intensity, pain duration and were greater amongst subjects who had sought a consultation. Results of factor analysis identified two constructs: physical and psychosocial disabilities, associated with orofacial pain. The Cronbach's alpha score was 0.78 and 0.92 for the physical and psychosocial constructs, respectively, and this along with item correlation values between 0.43 and 0.80 confirmed the internal consistency. CONCLUSION: We have therefore designed a valid instrument for assessing the impact of painful orofacial conditions in both community and clinic settings.     

Long-lasting orofacial pain--a study of 109 consecutive patients referred to a pain group

The aim was to register and evaluate the orofacial pain condition, with special focus on the equalities/inequalities between the sexes, in consecutive patients referred to the pain group at the Centre for Oral Health Sciences in Malm?, Sweden. The 109 patients, 85 (78%) women and 24 (22%) men, were referred to the pain group during the years 1988 to 1993 and were clinically examined using a standardised procedure. Pain duration of one year or more was experienced by 83% of the patients. The pain onset was related to dental care or toothache by 56% of the patients. Temporomandibular disorders were the most common diagnoses (52%) and were more common among women than among men (p < 0.05). Multiple pain locations were frequently reported, range 1-47 locations, and the women had significantly (p < 0.05) more pain locations than the men. Equalities between the sexes were more frequent than inequalities among patients referred for long-lasting orofacial pain. It can be discussed whether the sex difference in the prevalence of pain of musculoskeletal origin emerges from biological differences or can be explained by different psychosocial circumstances.     

Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headache, and psychosocial factors among non-patients

The aims of this study were to assess the prevalence of temporomandibular joint related (TMJ) painless symptoms, orofacial pain, neck pain, and headache in a Finnish working population and to evaluate the association of the symptoms with psychosocial factors. A self-administered postal questionnaire concerning items on demographic background, employment details, perceived general state of health, medication, psychosocial status, and use of health-care services, was mailed to all employees with at least 5 years at their current job. The questionnaire was completed by 1339 subjects (75%). Frequent (often or continual) TMJ-related painless symptoms were found in 10%, orofacial pain in 7%, neck pain in 39%, and headache in 15% of subjects. Females reported all pain symptoms significantly more often than men (P < 0.001). Frequent pain and TMJ-related symptoms were significantly associated with self-reported stress, depression, and somatization (P < 0.001). Perceived poor general state of health (P < 0.001), health care visits (P < 0.001), overload at work (P < 0.001), life satisfaction (P < 0.05), and work satisfaction (P < 0.05) were also significantly associated with pain symptoms, but the work duty was not (P > 0.05). Our findings are in accordance with earlier studies and confirm the strong relationship between neck pain, headache, orofacial pain. TMJ-related painless symptoms, and psychosocial factors. Furthermore, TMJ-related symptoms and painful conditions seem to be more associated with work-related psychosocial factors than with type of work itself.     

Classification of chronic orofacial pain using an intravenous diagnostic test

Summary  The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of conducted pharmacodiagnostic tests, consisting of the consecutive intravenous administration of drugs. Visual analogue scale scores were retrieved from all patients, based on which they were classified into different responder groups. In total, 46 pain profiles were analysed. Of these, 16 patients (35%) could be classified into one or more pain categories, while 30 patients (65%) could not be classified into any pain category. The pain duration or medication use did not influence the classification. Based on the results of this retrospective study, it seems that classification into subgroups is possible after intravenous testing in a minority of clinically unclassifiable patients. In patients where there is a substantial need for additional diagnostic information, these results may be of value. Recommendations are made for further research, which should include validation in patients with known pain mechanisms.     

Changes in reported orofacial symptoms over a ten-year period as reflected in two cohorts of fifty-year-old subjects

OBJECTIVE: The study presents changes in reported orofacial symptoms over the course of a 10-year period. It was hypothesized that there was an increase of temporomandibular disorder (TMD) and orofacial pain symptoms during the period concurrent with social and demographic changes. MATERIAL AND METHODS: All 50-year-old subjects living in two Swedish counties were asked to answer a mail questionnaire in 1992 and 2002. In the two cohorts, 6,343 and 5,798, respectively, responded (response rate 71.3% and 70.2%). RESULTS: Striking differences in demographic, occupational, general, and oral health conditions were found. General health was reported to be less good, utilization of dental care decreased, whereas number of teeth increased. The prevalence of a number of intra-oral symptoms and orofacial symptoms increased significantly between 1992 and 2002. Reported bruxism increased from 18% in 1992 to 28% in 2002. CONCLUSION: The observed increase in reported orofacial pain symptoms during the 10-year period, concurrent with changes in society, deserves further attention by society and the dental community.