Oral medicine integrates principles of medicine and dentistry for the diagnosis and management of disorders affecting the oral and maxillofacial region, as specified by the American Academy of Oral Medicine (available at https://www.aaom.com/; accessed 21 October 2020).

The specialty encompasses orofacial pain disorders, temporomandibular disorders, salivary gland disorders, systemic diseases leading to oral complications, malignant conditions, and oral mucosal conditions. Oral medicine clinics manage medically complex patients and serve as diagnostic and referral centres [1].

Reports from hospital-based oral medicine services have identified immune-mediated diseases, neuropathic pain, and potentially malignant oral disorders among the most common clinical presentations, and the distribution of cases varies considerably between centres. Moreover, data from university oral medicine clinics show a wide range of cases and stress the need for regional data to improve staff training, triage, and service development [2].

International studies have documented considerable geographic variation in the pattern and spectrum of oral medicine cases. Han et al. analysis of oral medicine services in New Zealand and China showed changing patterns in oral medicine case profiles [3], whereas Coppola et al. found a high prevalence of potentially malignant and immune-mediated conditions in a university-based oral medicine clinic in Italy [4]. Conversely, Villa et al. reported immune-mediated conditions and orofacial pain disorders as the most predominant presentations in United States-based oral medicine clinics [5]. These findings collectively reflect variability in diagnostic profiles between public and private settings [2], while some hospital-based studies show common presentations in academic centres [5], emphasising the need for accurate triage [4].

Studies across different regions of South Asia further emphasise the burden of oral mucosal lesions and the influence of local risk factors (e.g., tobacco, areca nut, denture use) and comorbidity on lesion patterns. Studies from South Asia consistently report a high frequency of oral mucosal lesions, although the distribution varies according to age, gender, local habits, and healthcare setting [6]. Similarly, clinic-based studies originating from South Asia, including India, have documented mucosal disorders in tertiary care environments [7].

Pakistani studies have addressed different aspects of the oral disease burden. Shabir et al. described the spectrum of distribution of oral and maxillofacial pathologies that were histologically confirmed [8], and Ali et al. reported considerable diagnostic delays in patients of oral mucosal and premalignant conditions [9]. Hospital-based studies revealed a significant proportion of oral mucosal lesions in dental outpatients [10], while Akhlaq et al. also showed a high frequency of reactive and potentially malignant lesions in Karachi-based patients [11].

Despite the increasing burden of oral diseases, there is limited evidence regarding the spectrum of patients presenting to oral medicine departments in Pakistan, a gap this research aims to address. By documenting the spectrum and frequency of specialised oral medicine cases, this study seeks to establish region-specific quality indicators that may guide resource allocation, curriculum development, and multidisciplinary patient care, while supporting earlier diagnosis and more effective clinical management. Therefore, this study aimed to characterise the pattern of presentation, demographic characteristics, diagnostic categories, management modalities, and referral destinations of specialised oral medicine cases presenting to a tertiary dental care centre in Lahore, Pakistan, between 4 August and 4 November 2025. This aim was achieved: the study yielded a complete case-mix profile of the study period, from which diagnostic, management, and referral patterns could be described and compared with other settings.

Study Design and Setting

A three-month descriptive retrospective cross-sectional study was conducted in the Department of Oral Medicine and Diagnosis at Lahore Medical and Dental College (LMDC), Lahore, Pakistan. The study period, from 4 August to 4 November 2025, corresponded to the dates of patient attendance. Retrospective data abstraction and analysis were conducted after ethical approval was obtained from the Institutional Review Board of LMDC (IRB No. FD/258/26; 22 January 2026).

LMDC is one of the largest dental centers in Lahore, receiving referrals from city hospitals, clinics, and different regions of Pakistan. The findings therefore reflect the case mix, management patterns and referral pathways of specialised oral medicine presentations encountered at this tertiary care service rather than population-level patterns in Pakistan. This observational study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies [12].

 Eligibility and Sampling

A criterion-based consecutive complete-enumeration approach was used. All consecutive patient records from the predefined study period that met the eligibility criteria for a specialised oral medicine presentation were included. Therefore, no random sampling or prior sample-size calculation was performed.

Cases were eligible when the clinical record contained a documented specialised oral medicine condition and sufficient information to classify the primary diagnosis, management modality and referral destination. A specialised case was defined as an unusual or complex oral condition requiring specialist diagnostic assessment, additional investigation, multidisciplinary evaluation or condition-specific management beyond routine dental care [5].

Routine presentations more appropriately managed as standard endodontic, periodontal, restorative or surgical dental conditions were excluded, even when they initially appeared clinically unusual. Follow-up visits relating to the same clinical episode and duplicate records were also excluded.

Eligibility was determined retrospectively from the final diagnoses documented in the clinical records. The authors assessed each case in consultation with a senior oral medicine specialist. Eligibility decisions and diagnostic categorisation were subsequently reviewed by the specialist, and no disagreements occurred.

 Data Collection and Variable Classification

Data were manually extracted from patient record cards using a structured data-collection form. The recorded variables were age, sex, primary diagnosis, management modality and referral destination. All 118 eligible records contained complete information for these variables; therefore, no records were excluded because of missing data.

Each patient was assigned one primary diagnosis corresponding to the main reason for presentation. Because the individual diagnoses were clinically diverse and several occurred infrequently, they were consolidated into six broader categories according to shared clinical and anatomical characteristics. The classification framework was reviewed and approved by a senior oral medicine specialist before statistical analysis.

Management modality represented treatment provided during the index clinical episode in the Department of Oral Medicine and was classified as conservative or surgical. Conservative management included pharmacological treatment and other non-invasive measures. Surgical management included incision and drainage, biopsy, excision or another invasive procedure planned or documented in the clinical record.

Referral destination was recorded separately from the management modality. Patients could therefore receive initial management within the department and subsequently be referred for further assessment or definitive treatment. Referral destinations were grouped into four categories: Oral and Maxillofacial Surgery; Restorative Dentistry, including operative dentistry, crown and bridge, and prosthodontics; other specialised dental services, including periodontics, paediatric dentistry and orthodontics; and no referral.

 Ethical Approval

Ethical approval for this study was granted by the Institutional Review Board of Lahore Medical and Dental College (IRB No. FD/258/26, dated 22 January 2026). The study was performed in accordance with the Declaration of Helsinki. As this was a retrospective analysis of de-identified clinical records involving no direct contact with patients, individual informed consent was not required or obtained; this is consistent with the retrospective, anonymised design of the study reviewed and approved by the Institutional Review Board. The analysis was limited to existing retrospective records, and all data were de-identified before analysis. Patient confidentiality and anonymity were maintained in accordance with ethical standards and institutional review board approval.

 Statistical Analysis

Data were analysed using IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA). Continuous variables were summarised using mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Ninety-five per cent confidence intervals were calculated for key proportions. Associations between diagnostic category, management modality and referral destination were assessed using the Pearson chi-square test. Because some cross-tabulation cells had expected frequencies below five, Monte Carlo estimation was used to obtain valid p values. Cramér’s V was calculated to determine the strength of association, with values of approximately 0.10, 0.30 and 0.50 interpreted as small, moderate and large effects, respectively. Statistical significance was set at p < 0.05.

The study involved a total of 118 participants, with a higher female representation (60.2%) than males, as shown in Table 1. The age distribution ranged from 2 to 67 years, with a mean of 33.23 ± 16.32 years, and most participants belonged to the 21–40-year age group.

 Table 1. Socio-demographic characteristics of the study participants (N = 118)

The diagnostic pattern revealed that Orofacial pain and temporomandibular disorders were the most common diagnostic category (24.6%; 95% CI 17.7–33.1), followed by Acquired Functional Restrictions & Drug-Induced Conditions (17.8%; 95% CI 11.9–25.7), Oral Mucosal Pathologies & Soft Tissue Lesions (16.9%; 95% CI 11.2–24.7), and Maxillofacial Trauma, Neoplasia & Hard Tissue Defects (16.1%; 95% CI 10.6–23.8). A detailed distribution is shown in Table 2.

 Table 2. Distribution pattern of specialised oral medicine cases and dental diagnoses (N = 118)

PGCG: peripheral giant cell granuloma.

 A statistically significant association was found between the diagnostic category and the type of management used (Pearson chi-square test with Monte Carlo estimation: χ² = 28.94, df = 5, p < 0.001, Cramér's V = 0.50, indicating a large effect), as shown in Table 3. Overall, 66.9% of patients were treated conservatively (95% CI 58.0–74.8) and 33.1% underwent surgical intervention. Conservative management was universal among Developmental Anomalies & Dental Structural Defects (100%) and prevailed in Orofacial pain and temporomandibular disorders (86.2%), Oral Mucosal Pathologies & Soft Tissue Lesions (70.0%), and Maxillofacial Trauma, Neoplasia & Hard Tissue Defects (63.2%).

Table 3. Comparison of management modalities across diagnostic categories (N = 118)

* Chi-square test; χ² = 28.94, df = 5, p < 0.001, Cramér's V = 0.50. Two of 12 cells (17%) had expected counts < 5. Percentages are row percentages within each diagnostic category. Monte Carlo estimation was used to obtain p values for analyses containing sparse expected cell frequencies.

 Maxillofacial Infections & Inflammatory Conditions were the only category in which surgical therapy predominated (80.0%), followed by Acquired Functional Restrictions & Drug-Induced Conditions (47.6%), the majority of which were cases of limited mouth opening. The Monte Carlo method was used to verify the p values and to account for cells with low expected counts, which affected 2 of 12 cells (17%) in Table 3 and 15 of 24 cells (62%) in Table 4.

Diagnostic categories and referral destinations were significantly associated (Chi-square test; χ² = 95.53, df = 15, p < 0.001; Cramér's V = 0.52, indicating a large effect). Oral and Maxillofacial Surgery received the largest share of referrals overall (46.6%), as shown in Table 4, and was the principal destination for Maxillofacial Trauma, Neoplasia & Hard Tissue Defects (78.9%), Acquired Functional Restrictions & Drug-Induced Conditions (61.9%), and Maxillofacial Infections & Inflammatory Conditions (60.0%). Developmental Anomalies & Dental Structural Defects were referred almost exclusively to Restorative Dentistry (78.6%). By contrast, 60.0% of Oral Mucosal Pathologies & Soft Tissue Lesions cases and 51.7% of Orofacial pain and temporomandibular disorder cases required no referral and were managed within the department itself.

Table 4. Referral patterns across diagnostic categories and departments (N = 118)

* Chi-square test with Monte Carlo estimation (15 of 24 cells [62%] had expected counts < 5); χ² = 95.53, df = 15, p < 0.001, Cramér's V = 0.52. Percentages are row percentages within each diagnostic category. Restorative includes operative dentistry, crown and bridge, and prosthodontics; Specialised includes periodontics, paediatric dentistry, and orthodontics.

The findings revealed a female predominance (60.2%), consistent with prior regional studies reporting higher female presentation rates for mucosal lesions and temporomandibular disorders, although the reasons for this pattern cannot be determined from the present data. The peak incidence (21–40 years) and the mean age (33.23 years) reflect the impact of trauma, infection, and stress-induced orofacial pain in the working population.

Orofacial pain and temporomandibular disorders formed the largest diagnostic category, mirroring hospital-based oral medicine services elsewhere in which orofacial pain is a leading reason for referral. In a North Indian tertiary dental hospital, Chaurasia et al. reported temporomandibular disorders in 61.2% of attendees [13], underscoring the burden of these conditions in specialist dental settings. The notable proportion of trauma is similar to that reported by Alshammary et al., who found that 44% of participants in Ha'il, Saudi Arabia, had experienced dental trauma [14].

Limited mouth opening (12.7%), predominantly related to oral submucous fibrosis, echoes South Asian series in which oral submucous fibrosis is a leading mucosal diagnosis, reported at 22% by Shahzad et al. [15] and 21% by Singh et al. in Rajasthan, India [16]. Although areca nut, betel quid, and smokeless tobacco use are well-established regional risk factors for oral submucous fibrosis and are plausible contributors in this setting, exposure data were not collected in the present study; these associations are therefore offered as context rather than as study-derived findings. Most of these cases occurred in the 21–40-year working-age group. Given the recognised malignant transformation potential of oral submucous fibrosis reported in Pakistani cohorts [17], its concentration in the working-age population may carry public health relevance, and oral medicine departments are well placed to contribute to early detection and preventive education.

The detection of malignancies (5.1%) and fascial space infections (8.5%), supported by Kashif et al., who demonstrated a similarly high frequency (57.5%) [18], reinforces the department's role in oncological screening and the management of life-threatening infections. Drug-induced complications (5.1%) demonstrate that the department plays a vital role in managing the oral side effects of systemic therapy, as highlighted by Shahzad et al. [15].

The 16.9% frequency of oral mucosal pathologies mirrors the findings of Ram et al., who documented a 31.1% frequency of oral mucosal lesions, with leukoplakia being the most common clinical finding [10]. Tongue lesions accounted for 8.5% and immune-mediated lesions for 6.8%, supported by Mirza et al., who found a common occurrence of tongue lesions (14.4%) in a combined sample from Punjab and Sindh [19]. Villa et al. reported immune-mediated conditions (27.2%) and orofacial disorders (21.2%) in United States-based oral medicine clinics [5].

The high presentation rate of Developmental Anomalies & Dental Structural Defects (11.9%), of which 6.8% were dental anomalies, agrees with research by Shirazi et al., in which enamel abnormalities were found to occur commonly in primary teeth (14.7%) [20], and by Shahzad et al., who found a wide occurrence of oral anomalies (developmental defects) and other general pathologies [21].

The conservative treatment rate of 70.0% for Oral Mucosal Pathologies & Soft Tissue Lesions shows that oral medicine practitioners can practise independently, consistent with international conservative-management practices supported by Sun et al. [22]. This is particularly important in Pakistan owing to the high prevalence of mucosal diseases in the region, which requires pharmacological rather than surgical skills, as detailed by Akhlaq et al. [11].

However, Ali et al. recognised an important diagnostic delay for oral malignancy and premalignancy cases in Pakistan, observing that the majority of patients present at advanced stages requiring surgery [9]. In the present series, by contrast, Orofacial pain and temporomandibular disorders were managed conservatively in 86.2% of cases, consistent with conservative-first protocols for these conditions and suggesting that such patients reached the service before irreversible joint pathology had developed. Surgical management instead concentrated in infectious and inflammatory conditions (80.0%), where drainage of fascial space infection is the definitive treatment rather than a marker of delayed presentation. Trauma-associated pain nonetheless remains a recognised driver of more invasive management in Pakistani tertiary settings, as reported by Alam and Shah [23].

In the Pakistani socioeconomic context, patients often refrain from seeking care until symptoms worsen. This pattern is well documented locally: in a survey of 400 patients attending a tertiary care dental hospital in Lahore, Waseem et al. showed that 87.5% had not consulted a dentist when their symptoms first appeared, with self-medication (24.57%) and the expectation that symptoms would resolve spontaneously (17.17%) the most frequently cited reasons for delay [24]. Hence, although oral medicine is a predominantly non-invasive specialty, surgical management was still required in approximately one third of cases overall, concentrated in infections and in limited mouth opening. Strengthening collaboration between dental clinics, specialised oral medicine units, and other specialties could shift this balance and allow more conservative therapies before advanced complications occur.

Notably, 51.7% of Orofacial pain and temporomandibular disorder cases and 60.0% of Oral Mucosal Pathologies & Soft Tissue Lesions cases were retained and managed within the department without onward referral. This suggests that the service absorbs a substantial share of complex non-surgical workload rather than acting purely as a conduit to other specialties, while still functioning as an important triage point within this tertiary care centre, as supported by Ramos et al. [2].

Patients with complicated Orofacial pain and temporomandibular disorders often move between general practitioners, otorhinolaryngologists, and neurologists before receiving a definitive diagnosis. By providing a central multidisciplinary hub, the department successfully filters cases by differential diagnosis, supported by Helmer et al., who established a strong clinical correlation between facial trauma and the development of temporomandibular disorders [25]. The concentration of Developmental Anomalies & Dental Structural Defects among Restorative Dentistry referrals (78.6%), predominantly fluorosis and ectopic eruption, shows that tooth-related developmental pathology requires specialised operative involvement, as mirrored by Jindwani et al. [7]. There is a need for specific equipment and skills among operative and prosthetic specialists.

Importantly, 60.0% of Oral Mucosal Pathologies & Soft Tissue Lesion cases did not require any referral, indicating the clinical independence of the oral medicine specialist. These conditions were immune reactions (e.g., lichen planus) and reactive lesions treated via conservative drug therapy, as demonstrated by Goyal et al., confirming that such conditions in tertiary clinics are effectively treated by conservative pharmacological protocols alone [6].

Overall, 46.6% of cases required consultation with Oral and Maxillofacial Surgery, underscoring the close collaboration between the two specialties at the tertiary level [18], whereas mucosal diseases were largely retained within the department, with only 5.0% referred onward.

These findings represent baseline data from a single tertiary urban centre and cannot be generalised to the wider Pakistani population. Multicentre studies with standardised data collection would help establish national reference data on oral medicine case-mix and referral pathways. Due to the retrospective nature of the study, there was inconsistent information about localized risk behaviors (e.g. betel quid use, smokeless tobacco use), and they could not be consistently related to mucosal diseases. The findings should be interpreted within the defined scope of this study. The three-month, single-centre design provided a focused assessment of specialised oral medicine presentations at a high-volume tertiary dental care service. Complete enumeration of all consecutive eligible cases during this period minimised selective sampling within the study population and ensured complete data for the variables analysed. However, the sample size of 118 limited the precision of estimates for less frequent diagnostic subgroups, and the short observation period may not have captured rare or seasonally varying presentations. As the analysis was based on retrospective clinical records, it was restricted to routinely documented information. Future multicentre studies conducted over longer periods may build on these findings and provide broader estimates of specialised oral medicine case patterns, management modalities and referral pathways.

The findings demonstrate that specialised oral medicine clinics manage a diverse spectrum of complex oral diseases, with significant associations between diagnosis, management strategy, and referral pathway. They support the role of oral medicine as a multidisciplinary diagnostic and triage service within tertiary dental care and provide baseline data for future multicentre studies in Pakistan. They also suggest opportunities to strengthen primary-level screening and earlier referral pathways to reduce the need for advanced surgical intervention. For clinicians, these patterns show that early diagnosis and structured triaging in oral medicine prevent severe complications and move patients toward timely conservative care. For policymakers, these findings may help inform the development of specialised triage pathways that could streamline patient routing and reduce reliance on late-stage surgical intervention.

 Acknowledgments

The authors would like to thank the Principal, Dental College, Lahore Medical and Dental College (LMDC), for their support and encouragement throughout this study, and the Department of Oral Medicine at LMDC for providing the facilities and access to the records required to conduct this study.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

 Conflicts of Interest

The authors declare that there is no conflict of interest to disclose.

1. Glick M, Greenberg MS, Lockhart PB, Challacombe SJ (2021) Burket's Oral Medicine. 13th ed. Hoboken (NJ): Wiley-Blackwell. pp. 1-8.
2. Oral Medicine: a retrospective analysis of patient profiles, diagnoses, and referral patterns in Mexico City. Figueroa-Ramos AM, Anaya-Saavedra G, Irigoyen-Camacho ME, Mosqueda-Taylor A. Med Oral Patol Oral Cir Bucal. 2025 Nov 1;30(6):e898-e905. PMID: 40818117.
3. Oral medicine services: a two-centre study of 99,603 patients between 2015 and 2020. Han C, Mei L, Liu A, Hassan SYM, Polonowita A, Guan G. J Int Med Res. 2022 Aug;50(8):03000605221115384. PMCID: PMC9364210.
4. Referral Patterns in Oral Medicine: A Retrospective Analysis of an Oral Medicine University Center in Southern Italy. Coppola N, Baldares S, Blasi A, Bucci R, Spagnuolo G, Mignogna MD, Leuci S. Int J Environ Res Public Health. 2021 Nov 19;18(22):12161. PMID: 34831914.
5. Oral Medicine referrals at a hospital-based practice in the United States. Villa A, Stock S, Aboalela A, Lerman MA, Woo SB, Sonis ST, Treister NS. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Apr;119(4):423-9. PMID: 25758844.
6. A Clinical Study of Oral Mucosal Lesions in Patients Visiting a Tertiary Care Centre in Central India. Goyal R, Jadia S, Jain L, Agarawal C. Indian J Otolaryngol Head Neck Surg. 2016 Dec;68(4):413-416. PMID: 27833864.
7. A retrospective study of diagnostic profile of patients attending dental outpatient department at a tertiary care centre in central India. Jindwani K, Singh K, Shrivastava GP, Gaharwar AP. J Evol Med Dent Sci. 2015 Jul 23;4(59):10277-10284.
8. First comprehensive report on distribution of histologically confirmed oral and maxillofacial pathologies; a nine-year retrospective study. Shabir H, Irshad M, Durrani SH, Sarfaraz A, Arbab KN, Khattak MT. J Pak Med Assoc. 2022 Apr;72(4):685-690.
9. Diagnostic delay for oral malignant and premalignant disorders in patients presenting with clinically evident oral mucosal lesions. Ali MF, Askary G, Mehdi H, Khan A, Kaukab H, Saran S. Pak Oral Dent J. 2022;42:14-20.
10. Distribution of Oral Mucosal Lesions Among Patients Visiting Qamar Dental Hospital in Karachi. Ram K, Ali I, Khalid TF, Aziz J, Aziz J, Fatima M, Saleem E, Ali A, Khero R. J Neonatal Surg. 2025;14(32S):9115-9120.
11. Prevalence and risk factors of oral mucosal lesions: a retrospective study of patients attending Oral Diagnosis Department of SIOHS Karachi, Pakistan. Akhlaq H, Khan MS, Nasir M, Sheikh H, Mehmood N, Sajjad I. Pak J Med Health Sci. 2021;15:3273-3276.
12. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Lancet. 2007 Oct 20;370(9596):1453-7. PMID: 18064739.
13. Temporomandibular disorders in North Indian population visiting a tertiary care dental hospital. Chaurasia A, Ishrat S, Katheriya G, Chaudhary PK, Dhingra K, Nagar A. Natl J Maxillofac Surg. 2020 Jan-Jun;11(1):106-109. PMID: 33041586.
14. Prevalence and Risk Factors of Dental Trauma in Ha'il, Saudi Arabia. Alshammary F, Alhur T, Alshammari KN, Siddiqui AA, Abideen MZU, Alghaythi KS, Ilyas M, Alam MK. J Contemp Dent Pract. 2022 Jun 1;23(6):628-633. PMID: 36259303.
15. Prevalence of systemic diseases in patients seen at oral medicine department. Shahzad M, Moosa Y, Kumar A, Mushtaq M, Aziz F. Pak Oral Dent J. 2018;38:337-340.
16. Prevalence of oral mucosal lesions in Sriganganagar, Rajasthan. Singh A, Yadav S, Kumar R, Mehta R, Mutneja S. J Adv Med Dent Sci Res. 2024;12:62-65.
17. High risk of malignant transformation of oral submucous fibrosis in Pakistani females: a potential national disaster. Mohiuddin S, Fatima N, Hosein S, Fatima N. J Pak Med Assoc. 2016 Nov;66(11):1362-1366. PMID: 27812049.
18. Evaluation of burden of oral pathologies at a tertiary care hospital in Karachi, Pakistan. Kashif M. Pak Oral Dent J. 2020;40:88-92.
19. Prevalence of tongue lesions in patients visiting private dental practices of Pakistan: a multicentre study. Mirza D, Devi B, Salman S, Khalid A, Omer SA, Zeeshan J. Med Forum Mon. 2022;33:45-49.
20. Developmental defects of enamel and in primary teeth. Shirazi N, Adnan K, Gul Z, Abbas SN, Ahmed A, Khan N. Int J Pharm Res Technol [Internet]. 2025 May 14;15(1):682-689. Available from: https://www.ijprt.org/index.php/pub/article/view/458
21. Prevalence of oral anomalies and pathologies in the Pakistani population: a cross-sectional study. Shahzad A, Kiyani A, Paiker S. J Pak Dent Assoc. 2018;27:13-17.
22. Analysis of clinical oral medicine practices at the University of Pennsylvania: a 5-year retrospective study. Sun M, Sollecito TP, Greenberg MS, Pinto A, Stoopler ET. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Mar;129(3):215-221.e6. PMID: 32044266.
23. The frequency of trauma-associated pain among other orofacial pain in patients attending dental and maxillofacial outpatient clinics of a tertiary care hospital. Alam S, Shah S. J Rehman Coll Dent. 2025;6:27-30.
24. Reasons for not seeking early dental care in patients presenting in the exodontia department at a tertiary care hospital in Lahore, Pakistan. Waseem A, Hussain V, Zahid RB, Shahbaz M. Professional Med J. 2021;28:1107-1113.
25. Trauma and TMD: the association between orofacial trauma and temporomandibular disorders in a tertiary referral clinic. Helmer LML, Koutris M, Chattrattrai T, Su N, Dubois L, de Lange J, Lobbezoo F. Cranio. 2026;44:171-179.