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Practice Guideline
. 2012 Mar;39(3):161-9.
doi: 10.1111/j.1365-2842.2011.02247.x. Epub 2011 Aug 18.

Classifying Orofacial Pains: A New Proposal of Taxonomy Based on Ontology

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Practice Guideline

Classifying Orofacial Pains: A New Proposal of Taxonomy Based on Ontology

D R Nixdorf et al. J Oral Rehabil. .
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We propose a new taxonomy model based on ontological principles for disorders that manifest themselves through the symptom of persistent orofacial pain and are commonly seen in clinical practice and difficult to manage. Consensus meeting of eight experts from various geographic areas representing different perspectives (orofacial pain, headache, oral medicine and ontology) as an initial step towards improving the taxonomy. Ontological principles were introduced, reviewed and applied during the consensus building process. Diagnostic criteria for persistent dento-alveolar pain disorder (PDAP) were formulated as an example to be used to model the taxonomical structure of all orofacial pain conditions. These criteria have the advantage of being (i) anatomically defined, (ii) in accordance with other classification systems for the provision of clinical care, (iii) descriptive and succinct, (iv) easy to adapt for applications in varying settings, (v) scalable and (vi) transferable for the description of pain disorders in other orofacial regions of interest. Limitations are that the criteria introduce new terminology, do not have widespread acceptance and have yet to be tested. These results were presented to the greater conference membership and were unanimously accepted. Consensus for the diagnostic criteria of PDAP was established within this working group. This is an initial first step towards developing a coherent taxonomy for orofacial pain disorders, which is needed to improve clinical research and care.


Fig. 1
Fig. 1
Conceptual framework for Ontology of General Medical Science (OGMS). The OGMS pursues a view of disease as resting in every case on some (perhaps as yet unknown) physical basis (Williams, 2007) (33). When, for example, there is a persistent pain in some body part of a person, this is because (1) some physical structure or substance in the person is disordered (e.g. there is a gingival lesion or damage to a nerve) as a result of which (2) there exists a disposition for the person to undergo processes that can be qualified as being pathological. In many cases, patients thus harbour disorders before the associated dispositions are realised in changes some of which may become observable. Once observable, these changes are usually first recognised by patients (symptoms) and subsequently observed by clinicians (signs). All changes brought about by a disorder constitute the disease phenotype that can exist without being observed. Indeed, as technology advances, our ability to detect the underlying components of a disease phenotype will expand. What is observed, including erroneous beliefs about manifestations, becomes interpreted and leads to a diagnoses.
Fig. 2
Fig. 2. Diagnostic Criteria for PDAP
Criteria: 1persistent meaning pain present at least 8 h per day ≥15 days or more per month for ≥3 months during 2pain is defined as per IASP criteria (includes dysesthesia) 3localised meaning the maximum pain defined within an anatomical area 4extent of evaluation non-specified (dental, neurological examination +/−) imaging, such as intra-oral, CT and / or MRI).

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