8 - Orofacial Pain Flashcards
the most common cause of pain in the orofacial region is what in origin
inflammatory disease of pulpal origin
before treating a patient in pain, what is imperative
correct diagnosis is imperative
what is this:
gating mechanism in the substantia gelatinosa of the spinal cord and brainstem on which both peripheral nerve fibers and descending central influences exert their effect in pain experience
gate control theory
principles of gate control theory
- descending control mechanisms from higher central nervous centers
- cognitive, motivational and affective processes
- degree of activity in large-diameter and small diameter nerve fibers
- large diameter fibers are activated by non-noxious stimuli and close the gate
- small diameter fibers are activated by noxious stimuli and “open the gate”
Large diameter fibers are activated by
___ and ___.
non-noxious stimuli and “close the gate”
Small diameter fibers are activated by
___ and ___.
noxious stimuli and “open the gate”
what is pain perceived to originate from a site with no damage
referred pain
what theory occurs when afferent nerves converge on same second order neuron
referred pain convergence theory
what are possible sources of referred pain
muscles, ear, sinuses, heart, and other teeth
can muscles of mastication refer pain to teeth
yes
where do you palpate muscles of mastication
muscle insertions
what provides myofascial pain dysfunction syndrome?
TMD/muscles of mastication -> patients with these condition describe toothache as one of their symptoms
what is referred pain from respiratory mucosa to teeth
sinus pain
where does sinus pain deliver pain
posterior maxillary teeth
what dose sinus pain feel like
tender to mastication and hypersensitive to cold, tenderness to pressure on cheeks, pain worsened by lowering head and jumping on heels
people with sinus pain have a history of what
history of respiratory infections and allergies
what is referred pain from angina pectoris or myocardial infarction
cardiac origin
which arch can perceive pain of cardiac origin?
EITHER arch! but left mandible is most common
occasionally, cardiac pain is only felt where
face and jaws
T/F: toothache is incapable of being referred to other teeth
FALSE! it is capable. there are many tooth pain referral patterns
what commonly refers pain to the ear
mandibular molars
as inflammatory mediators spread, can pain diffuse thru a wider area?
YES!
what are types of spreading pain
- primary spreading pain
- secondary spreading pain (muscle)
- allodynia
what is a pain due to a stimulus that does not normally provoke pain?
allodynia
e.g., light feather touch (that should only produce light sensation) causes pain
what are other sources of orofacial pain
- psychogenic pain
- neuritis
- neuralgia
- atypical orofacial pain
what pain:
- no identifiable origin
- multiple (especially bilateral pain sites)
- pain does not respond to therapy (especially analgesics)
- unusual, inconsistent, illogical non-anatomic pain patters
psychogenic pain
what pain:
- Pain has strong emotional and affective components
- Focus is on social and emotional problems
- Activity in higher centers may originate pain
- Mouth and face have important emotional significance
psychogenic pain
what is a tentative LAST RESORT diagnosis and indicates referral?
psychogenic pain
what pain:
- Pain is severe
- Trigger zone
- Usually limited to distribution of one branch of the trigeminal nerve
- Can mimic tooth pain
- Symptoms cannot be initiated by stimulating dental structures
trigeminal neuralgia
are headaches capable of referring pain to teeth and viceversa?
YES
types of headaches
- vascular headaches (migraine)
- cluster headaches
- tension headaches
what questions to ask to diagnose pain
- is pain of dental origin?
- which tooth is it?
you should always do what when doing pain diagnosis
always reproduce patient symptoms
what to do with difficult pain diagnosis
- provide symptomatic relief and observe patient
- seek an expert opinion
