Differences in self-reported orofacial pain and daily activities between children surveyed in metropolitan and provincial areas of Japan: a school-based cross-sectional survey

Orofacial pain (OFP) in children may be associated with daily activities and psychological factors; however, these characteristics may vary across geographical settings. Evidence regarding geographical differences in OFP and related daily activities among Japanese children remains limited. This study aimed to compare self-reported OFP characteristics, daily activities, and trait anxiety between children surveyed in one metropolitan area and one provincial area in Japan. This school-based cross-sectional survey included 923 children aged 11–12 years from selected elementary schools in a metropolitan area (MA; n = 480) and a provincial area (PA; n = 443). Data were collected in 2011–2012. Participants self-reported TMD-related symptoms, headache, neck pain, and toothache. Daily activities were assessed using a 15-item questionnaire and trait anxiety using the State-Trait Anxiety Inventory for Children–Trait (STAIC-T). Group differences were examined using t-tests, chi-square or exact tests. Associations with headache and neck pain were examined using univariable and multivariable logistic regression. Geographical area × daily-activity interactions were tested in the pooled sample with false discovery rate (FDR) correction. Age, sex distribution, STAIC-T scores, and the prevalence of self-reported TMD symptoms and toothache did not differ significantly between the geographical samples. Headache and neck pain were reported more frequently in the MA sample than in the PA sample ( p = 0.035 and p = 0.002, respectively). Several daily activities were associated with headache and/or neck pain in area-stratified multivariable analyses. In formal interaction analyses, only the association between use of a high pillow and headache differed significantly between the geographical samples after FDR correction; no daily-activity interaction for neck pain remained significant after FDR correction. Children surveyed in the metropolitan area reported headache and neck pain more frequently than those surveyed in the provincial area. Several self-reported daily activities were associated with headache and/or neck pain, although these associations should not be interpreted as causal or necessarily specific to either geographical area. Given the cross-sectional design, reliance on self-reported measures, and sampling from selected geographical areas, these findings should be interpreted cautiously and require confirmation in contemporary longitudinal studies.