09.10 orofacial pain Flashcards
what is the most common type of non cariogenic pain?
Dento-alveolar, except later he said that 90% of his patients have TMD
sialoliths:
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symptoms of TMD
- facial pain
- jaw clicks
- headaches
- ear pain
- neck pain
- tender teeth
- blurred vision
“biopsychosocial” concepts in the etiology of TMD
- Biopsychosocial concepts (psychosocial)
- psychological concepts (psycological)
- biomedical concepts (physical)
neuralgia
“nerve pain”
trigeminal neuralgia
- extreme unilateral pain right>left side
- peaks around 50-60 yr old (but can occur in younger
- primary (idiopathic)
- secondary: to brain tumors, ms or central lesions
- annual incidence: 12.8/100,000
Post-herpetic neuralgia
Herpetic infections associated with neuritic involvement of the trigeminal ganglion, sensory root or medullary track by varicella zoster virus (VZV)
• VZV causes primary chickenpox, latent virus can reactivate along the trigeminal nerve
• Management with neuropathic medications and antiviral medication
Glossopharyngeal Neuralgia (GPN)
- Severe, sudden, recurrent pain in the distribution of the glossopharyngeal nerve.
- Extremely rare : incidence about 0.7 / 100,000
- F > M, peaks over 50 yrs age
- Severe, stabbing pain in ear, base of tongue, tonsillar fossa or below the angle of mandible. May be triggered by swallowing, talking and coughing
- Secondary GPN : Presence of cranial lesion
Eagle’s syndrome
• To be included when entertaining a diagnosis of GPN
• Elongated styloid process which may elucidate pain by
impinging on adjacent anatomical structures.
• 4% of the population has elongated styloid process, and a small percentage (4 to 10%) may experience symptoms
• Associated with pain and dysphagia on chewing and turning head on affected side.
You don’t need to worry about this, don’t refer
Pain along trigeminal nerve may also be secondary to
- Trauma – including iatrogenic dental procedures
- Systemic diseases
- Scleroderma
- Sjogrens syndrome
- Systemic Lupus Erythromatosus
- Rheumatoid arthritis
- Dermatomyositis
- Mixed connective tissue disorder
- Pain and or numbness/ altered sensation in these patients along CN V may be related to vasculitis
Temporal Arteritis
- It is a form of cell mediated immune reaction causing vasculitis of blood vessels in the head and neck region
- While other vessels of the head and neck may be affected, vasculitis of the temporal artery if more common than other vessels
- Usual onset > 50 yrs age
- Females: Males in a 3:1 ratio
- May be closely associated to another immune-mediated inflammatory condition called polymyalgia rheumatica (diffuse inflammation thru out the body)
- Potential for sudden blindness (inflammation in the artery diminishes blood supply to the eye and optic nerve)
symptoms of temporal arteritis
- Symptoms include unilateral or bilateral headache describe as a throb or continuous, intense ache
- “Jaw claudication” : Pain on chewing
- Scalp tenderness – such as with brushing hair
- Visual changes including blurring or loss of vision
- Neural changes including optic neuropathy
treatment of temporal arteritis
Treatment of choice is high dose corticosteroids and prompt referral to a neurologist/neurosurgeon
Trigeminal Autonomic Cephalgias (TACs) (know the three types)
- Group of syndromes incorporating short unilateral headache attacks along with cranial autonomic symptoms along the ipsilateral side
- Cranial autonomic symptoms include ocular pain, lacrimation, eyelid edema, rhinorrhoea, ptosis and miosis
- Primarily symptoms occur along first division of trigeminal nerve
- TACs are of 3 types :
- Cluster Headaches (CH)
- Paroxysmal hemicrania (PH)
- Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
Atypical Facial Pain
• Persistent Idiopathic Facial Pain (PIFP) is classified by the International Headache Society as a persistent facial pain that does not have the classical characteristics of cranial neuralgias and for which there is no obvious cause.
• Pain needs to be localized, present daily and throughout all or most of the day to be labeled PIFP.
• Pain is confined to the area under the hairline, above the neck and in front of the ear.
• Pain is “deep” but has been described as aching, sharp and throbbing
• Pain may “migrate” to different quadrant or to ipsilateral side
-Diagnosis by elimination
