Prevalence and impact of orofacial pain in older adults with dementia: a systematic review and meta-analysis.
Mylena de Abreu Cardoso, Kaliane Rodrigues da Cruz, Rayane Délcia da Silva and 5 others
PMID 42561305WHAT IT FOUND
About 1 in 5 older adults with dementia has orofacial pain, though the true rate may be as low as 9% or as high as 31%.
These patients often cannot report pain, so clinicians should actively look for it rather than wait for complaints.
Key findings
01The pooled prevalence of orofacial pain in older adults with dementia was 19% (95% CI 9%–31%), with very high variability across the included studies (I² = 99%).
02Patients in more advanced stages of dementia, who had difficulty verbally reporting pain, were at higher risk of experiencing orofacial pain.
03The main factors linked to orofacial pain in this population were poor oral hygiene, having natural teeth, tooth pain, ulcers, and xerostomia; patients also showed higher rates of periodontal infections, cavities, and residual roots.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
Only 13 studies were available, and the authors acknowledge this limits how far the results can be generalised. The studies disagreed so much (I² = 99%) that the 19% pooled estimate has a very wide range (9%–31%), making it difficult to apply to a specific setting or patient group. The included studies used different settings (nursing homes, hospitals, clinics, community), different pain categories (odontogenic vs non-odontogenic), and different assessment tools, so the pooled figure blends quite different populations and measurement approaches. Progressive cognitive decline means many patients could not self-report pain; assessment relied on caregiver reports or behavioural observation, both of which are subject to interpretation and variability. The reliability of the OPS-NVI, a commonly used behavioural pain scale, is contested: one study found low favourable concordance and concluded it is not recommended as a screening tool, creating uncertainty about how well pain was actually measured across the included studies.
Declared interests
No financial support or conflicts of interest were declared.
The easy way to misread this
Do not treat the 19% figure as a precise prevalence for your own patient population. The confidence interval spans 9% to 31%, the studies disagreed so strongly (I² = 99%) that the true rate in any one setting could fall well outside that range, and the estimate depends heavily on how pain was assessed. Many patients could not self-report, and the behavioural scales used have contested reliability. A clinician who reads '19%' and concludes that roughly one in five of their own dementia patients has orofacial pain is over-interpreting what is, at best, a rough central estimate from a small and highly variable set of observational studies.