Orofacial pain and sensory disorders in the elderly

The actual prevalence of general pain in the elderly population is moderately high (ranging from 25% to 88%), and research suggests that 17.4% of the elderly will report one or more current or recent orofacial pains within a single year. Several causes of orofacial pain exist, including strong contraction-based movement disorders (such as dystonia and bruxism). Oral motor dysfunction is best managed with a multidisciplinary approach, including medications, protective devices (bite guards), and motor paralyzing injections (ie, botulinum toxin). One muscle condition that is more evident in the elderly than in younger patients is fibromyalgia. This chronic pain condition increases with age, affects up to 2% of the population, and is at least seven times more common in women. Several medications are used for FMS, but efficacy is low and tolerability remains a problem in the elderly. The best medications at present are the tricyclic medications (eg, nortriptyline), the sedative-hypnotics (zolpidem), and a weak opioid analgesic (tramadol). It is probably more important in the treatment of FMS that a physical medicine-behavioral treatment program be established and that the patient engage in daily physical exercise and relaxation. Another cause of orofacial pain is temporal arteritis, which is commonly seen in older people; the mean age of onset is 70 years. Treatment of temporal arteritis usually involves corticosteroids in a dose sufficient to relieve symptoms. Approximately two thirds of headache pain in the elderly is caused by migraines or tension-type headaches, but when a new headache develops in the elderly, the other third may have an intracranial lesion or a systemic disease. The difficulty with headaches in the elderly is that the medications used in a younger cohort are problematic for many reasons. A frequently misdiagnosed disease in the elderly is TN. Once it is fully developed, it presents as a sudden, usually unilateral, severe, brief, stabbing, recurrent pain. In the early stages of the disease, it is often mistaken for a toothache due to dental abscess. When the oral pain problem is a sustained pain in the teeth or gingival tissues, this condition is called atypical oral pain or atypical odontalgia; once the tooth is extracted and the pain continues, the term "phantom tooth pain" is used. This disorder is most likely due to a long-lasting and perhaps permanent neuropathic alteration in the trigeminal nerve. Other oral neuropathic diseases that affect the elderly are postherpetic neuralgia, BMS, and an unusual disturbance in the patient's sense of bite comfort, described as OD. Suggested treatments for these neuropathic diseases have been described.