Background/Objectives Orofacial pain in older adults with dementia is often overlooked due to cognitive decline and impaired communication, impairing patients’ quality of life and exacerbating neuropsychiatric behavioural symptoms. This scoping review aimed to map available evidence regarding prevalence, assessment tools, clinical management strategies and research gaps, with the aim of informing clinical practice and guiding future research. Methods Systematic literature searches were performed in PubMed, Web of Science, Embase and Cochrane Library from database inception to December 2025. Two independent reviewers performed literature screening and data extraction, and any disagreements were resolved via consensus discussion. Narrative synthesis was adopted to summarise findings, and the review strictly followed PRISMA-ScR guidelines. This review was retrospectively registered on the Open Science Framework on 5 March 2026 (OSF: <a href="https://osf.io/qmg64">https://osf.io/qmg64</a>). The literature search was completed prior to registration. Results Twenty one studies were included. Orofacial pain prevalence varied: 7.4%–21.7% in community-dwelling older adults; 11.9% (rest) and 21.9% (mastication) in hospitalised patients; up to 48.8% in nursing home residents with severe dementia. A meta-analysis (n = 6115) reported a pooled prevalence of 19.0%. Nearly half (50.3%) of patients without self-reported pain had underlying oral pathological lesions. Based on limited validation studies, the OPS-NVI demonstrates relatively stronger psychometric properties compared to other available tools, though evidence remains preliminary and head-to-head comparisons are lacking, while the OHAT-NL may be suitable for community screening by caregivers. Paracetamol is frequently recommended as a first-line option for mild to moderate pain based on general geriatric pain guidelines, but direct evidence for orofacial pain in dementia is limited. Multidimensional non-pharmacological strategies, including staged oral care, caregiver training and multidisciplinary collaboration, are generally suggested. Major systemic barriers include limited dental service access, insufficient caregiver training, and information fragmentation. Conclusions Orofacial pain represents a substantial underrecognised burden among older adults with dementia. Immediate priorities include integrating oral health assessment into routine care, promoting scenario-specific use of validated tools, and strengthening caregiver education. Future research should prioritise subtype-specific investigations and translate existing evidence into implementable clinical protocols.

Scoping review on orofacial pain management in older adults with dementia

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2026年7月3日

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Liang Kong,
FengLi Zhu,
LingHui Zhang,
Qian Yang

摘要

Background/Objectives

Orofacial pain in older adults with dementia is often overlooked due to cognitive decline and impaired communication, impairing patients’ quality of life and exacerbating neuropsychiatric behavioural symptoms. This scoping review aimed to map available evidence regarding prevalence, assessment tools, clinical management strategies and research gaps, with the aim of informing clinical practice and guiding future research.

Methods

Systematic literature searches were performed in PubMed, Web of Science, Embase and Cochrane Library from database inception to December 2025. Two independent reviewers performed literature screening and data extraction, and any disagreements were resolved via consensus discussion. Narrative synthesis was adopted to summarise findings, and the review strictly followed PRISMA-ScR guidelines. This review was retrospectively registered on the Open Science Framework on 5 March 2026 (OSF: https://osf.io/qmg64). The literature search was completed prior to registration.

Results

Twenty one studies were included. Orofacial pain prevalence varied: 7.4%–21.7% in community-dwelling older adults; 11.9% (rest) and 21.9% (mastication) in hospitalised patients; up to 48.8% in nursing home residents with severe dementia. A meta-analysis (n = 6115) reported a pooled prevalence of 19.0%. Nearly half (50.3%) of patients without self-reported pain had underlying oral pathological lesions. Based on limited validation studies, the OPS-NVI demonstrates relatively stronger psychometric properties compared to other available tools, though evidence remains preliminary and head-to-head comparisons are lacking, while the OHAT-NL may be suitable for community screening by caregivers. Paracetamol is frequently recommended as a first-line option for mild to moderate pain based on general geriatric pain guidelines, but direct evidence for orofacial pain in dementia is limited. Multidimensional non-pharmacological strategies, including staged oral care, caregiver training and multidisciplinary collaboration, are generally suggested. Major systemic barriers include limited dental service access, insufficient caregiver training, and information fragmentation.

Conclusions

Orofacial pain represents a substantial underrecognised burden among older adults with dementia. Immediate priorities include integrating oral health assessment into routine care, promoting scenario-specific use of validated tools, and strengthening caregiver education. Future research should prioritise subtype-specific investigations and translate existing evidence into implementable clinical protocols.