Orofacial pain and dementia: a brief narrative review of associations, putative mechanisms, and relevant clinical considerations.

Abstract

This review examines the possible association between orofacial pain and dementia by synthesizing current findings from clinical, observational, and mechanistic studies. Although chronic pain has been increasingly recognized as a factor linked to cognitive decline, the specific role of orofacial pain, including conditions such as temporomandibular disorders, trigeminal neuralgia, burning mouth syndrome, and primary headaches, remains underexplored. Given the distinct neuroanatomy of the trigeminal system and its close connection to emotional and cognitive processing, orofacial pain may involve unique mechanisms relevant to neurodegeneration. Studies suggesting possible links between orofacial pain conditions and cognitive impairment were identified, highlighting mechanisms such as neuroinflammation, locus coeruleus dysfunction, and central sensitization. Modifiable cofactors, including poor oral health and sleep disturbances, which may influence both pain and dementia risk and are particularly relevant in dental and orofacial clinical practice, were also examined. Pain assessment and management strategies for individuals with dementia were reviewed as well, with emphasis on the need for validated tools and interdisciplinary care models that incorporate dental and orofacial pain specialists. Given the heterogeneous and limited nature of existing studies, this review does not make causal claims but instead conceptually maps the current landscape, identifies critical gaps in the literature, and outlines implications for research and practice. Dentists and orofacial pain providers may be uniquely positioned to recognize pain-related risk factors in cognitively vulnerable patients and implement preventive or therapeutic strategies. Future longitudinal studies and mechanistic investigations are needed to clarify the direction and clinical significance of the orofacial pain-dementia relationship.