Diagnostic Frameworks for Orofacial Pain: A Systematic Review

Background: Orofacial pain (OFP) comprises a heterogeneous group of conditions with overlapping clinical manifestations that frequently complicate diagnosis and therapeutic decision-making. Diagnostic inaccuracies may contribute to delayed management, unnecessary dental procedures, and reduced quality of life. Despite the availability of standardized classifications and diagnostic criteria, their translation into routine clinical practice remains variable. Aim: This systematic review aimed to systematically identify, describe, and critically evaluate diagnostic frameworks proposed for the differential diagnosis of OFP. Diagnostic frameworks were broadly defined as structured approaches to clinical decision-making, including clinical practice guidelines (CPGs), classification systems, clinical algorithms, consensus documents, and other explicit diagnostic models. The review focused on their methodological quality, evidentiary support, clinical applicability, and operational utility in dental practice. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched using predefined terms related to OFP. Eligible studies included investigations assessing diagnostic protocols, clinical decision-making frameworks, or therapeutic implications in patients with OFP. Non-systematic expert opinions, editorials, and book chapters were excluded from the analysis. Data extraction and qualitative synthesis were performed independently by the reviewers. Results: A total of 184 records were identified through database searching. After duplicate removal and eligibility assessment according to the PRISMA flowchart, 12 studies were included in the qualitative synthesis. Additionally, the International Classification of Orofacial Pain (ICOP) was used as an external contextual reference framework and was not included in the PRISMA study count. The included studies demonstrated marked heterogeneity in diagnostic approaches, including theoretical, pathophysiological, clinical reasoning, classification-based, and algorithm-driven frameworks. Methodological quality was generally moderate to high. The scope and clarity domains showed the strongest performance, whereas development rigor remained limited across studies. Overall, clinically applicable frameworks frequently lacked methodological rigor. Conclusions: Current diagnostic frameworks for OFP remain methodologically heterogeneous and vary considerably in their degree of operationalization and empirical validation. Future diagnostic frameworks and CPGs should incorporate standardized terminology, reproducible diagnostic criteria, structured examination pathways, and clinically applicable recommendations to improve diagnostic consistency and facilitate implementation in routine practice.