The issues and challenges of orofacial pain in the elderly.

Dental pain is among the most prevalent of all pain complaints, and pain is frequently given as a common reason for both avoiding and seeking dental care. Pain is frequently an essential component in the differential diagnosis of many diseases; however, in the elderly, diagnosis is more difficult due to a greater frequency of multiple chronic diseases and an altered pain response. It is important to understand the nature and prevalence of pain in this group, and one should be cautious to avoid the oversimplification that "pain decreases with age." Current studies involving the differences in assessing pain and therapeutic pain control between younger and older age groups are discussed. Pain prevalence is discussed along with herpes zoster, post-herpetic neuralgia, fibromyalgia, toothache pain, burning mouth syndrome, and trigeminal neuralgia as they relate to the elderly. Pain assessment can be made by means of pain scales and specific open- and closed-ended questions. There is evidence that some practitioners may be underestimating the severity of pain in the elderly, and thus not prescribing adequate analgesics when indicated. When analgesics are prescribed, a thorough analysis of the patients' current medications and condition should lead to a customized prescription and dosage.