4th year facial pain Flashcards
Define pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
Define burning mouth syndrome
Intraoral burning or dysaesthetic sensation, recurring daily for > 2 hours over > 3 months without clinically evident causative lesion
2 epidemiological features of burning mouth syndrome
Incidence increases with age
7F:M
3 common features of the clinical presentation of burning mouth syndrome
Spontaneous burning/scalded sensation
Bilateral
Poorly localised
4 common locations of burning mouth syndrome
Tongue
Lips
Palate
Gingiva
Suggested aetiology of burning mouth syndrome
Likely neuropathic origin
3 classifications of burning mouth syndrome
Type 1: comes on as day goes on, unremitting
Type 2: on waking and throughout the day
Type 3: no regular pattern, atypical sites affected
4 local factors causing burning mouth syndrome
Dry mouth
Infections
Oral mucosal lesions
Allergic reactions
4 systemic factors causing burning mouth syndrome
Blood disorders
Autoimmune disorders
Endocrine disorders
GORD
4 topical therapies for the management of burning mouth syndrome
Clonazepam
Capsaicin
Difflam mouth rinse or spray
Laser therapy
4 systemic therapies for the management of burning mouth syndrome
Amitriptyline
Clonazepam
Gabapentin
Alpha lipoic acid
Define trigeminal neuralgia
Disorder of the trigeminal nerve that causes episodes of unilateral, intense, stabbing, electric shock-like pain
3 classifications of trigeminal neuralgia
Idiopathic: without other disease, no clinically obvious neurological cause
Primary/classical: signs of trigeminal nerve root compression
Secondary: occur in presence of organic disease
4 causes of secondary trigeminal neuralgia
Tumours of trigeminal nerve
Lesions affecting the trigeminal nerve
Demyelination
Cerebral neoplasms
5 common features of the clinical presentation of trigeminal neuralgia
Sudden, sharp, severe stabbing pain
Lasts few seconds to <2mins
Affects normally one branch of trigeminal nerve, unilateral
Entirely asymptomatic between attacks
2 epidemiological features of trigeminal neuralgia
More common in females
Onset usually 50-70 years
4 methods of diagnosing trigeminal neuralgia
Clinical history
Neurological assessment
MRI brain
MR angiography
1 medical management of trigeminal neuralgia
Carbamazepine
4 surgical managements of trigeminal neuralgia
Peripheral surgery
Intracranial surgery
Percutaneous surgery
Stereotactic gamma knife radiosurgery
Define giant cell arteritis
Immunological/vasculitic condition in which there is inflammation of medium sized arteries especially in the head and neck
2 epidemiological features of giant cell arteritis
More common in females
Affects older >50 yrs
3 common features of the clinical presentation of giant cell arteritis
Severe burning pain in distribution of the affected vessel
Affected artery may be enlarged and tender
Headache is intense, deep, aching, throbbing, persistent
3 methods of diagnosing giant cell arteritis
Clinical history
Raised ESR
Arterial biopsy
1 medical management of giant cell arteritis
Prednisolone systemic corticosteroid
Define glossopharyngeal neuralgia
Rare condition, causing repeated episodes of severe pain in the tongue, throat, ear, and tonsils
3 common features of the clinical presentation of glossopharyngeal neuralgia
Severe paroxysmal pain in post tongue/tonsillar region
Pain may radiate to the ear
Triggered by swallowing, coughing
1 medical management of glossopharyngeal neuralgia
Carbamazepine
Define periodic migrainous neuralgia
Unilateral, excruciating pain in the maxilla or behind the eye
3 common features of the clinical presentation of periodic migrainous neuralgia
Attacks last 30-60mins, awaken from sleep, end suddenly
Occur in early hours and repeat over several days
Often accompanied by conjunctival redness, photophobia
2 management strategies periodic migrainous neuralgia
Oxygen therapy
Sumatriptan subcut or nasal spray
Define paroxysmal hemicranias
Frequent, short-lasting (few minutes) attacks of unilateral pain
3 common features of the clinical presentation of paroxysmal hemicranias
Usually orbital, supraorbital or temporal region
5-40 attacks per day
Associated with conjunctival redness, nasal congestion, eyelid oedema
1 medical management of paroxysmal hemicranias
Indometacin NSAID
Define persistent idiopathic facial pain (PIFP)
A constant chronic orofacial discomfort or pain, for which no organic cause can be found
3 common features of the clinical presentation of persistent idiopathic facial pain (PIFP)
Pain poorly localised
Often multiple oral and/or other psychogenic related symptoms
Poor response to treatment
2 epidemiological features of persistent idiopathic facial pain (PIFP)
Affects 1-2% of population
Most commonly older females
2 common features of the clinical presentation of atypical facial pain
Usually upper jaw pain
Deep, dull, boring pain that persists for most or all of day
1 medical management for atypical facial pain
Amitriptyline
3 common features of the clinical presentation of migraines
Recurrent, incapacitating, unilateral headaches
Usually supraorbital
Last hours/days
3 epidemiological features of migraines
Common problem
F>M
Middle age
2 medical managements of migraines
Aspirin
Paracetamol
Define temporomandibular joint disorders
Group of musculoskeletal and neuromuscular disorders
4 epidemiological features of temporomandibular joint disorders
Most common cause of non-dental orofacial pain
Third most common chronic pain
Peak incidence is 2nd – 3rd decade
More common in females
Describe 3 features of acute TMD
Identifiable cause
Short duration
Resolves
Describe 2 features of chronic TMD
Pain exceeds 3 months
Becomes biopsychosocially destructive
4 common features of the clinical presentation of TMD
Head/neck pain
Limited range of motion
TMJ clicking or crepitus
Headache related to temporalis pain
5 self management strategies for TMD
Avoidance of parafunctional activities/habits
Relaxation techniques
Heat application
Jaw exercises
Soft diet
3 medical managements for acute TMD
NSAIDS
Paracetamol
Benzodiazepines
3 medical managements for chronic TMD
Antidepressants
Muscle relaxants
Masseter botox
5 reasons why patient may require referral for management of TMD
Multiple unsuccessful treatments
Psychological distress
Trismus
Chronic widespread pain
Disc displacement without reduction
