8 - Orofacial Pain Flashcards

1
Q

the most common cause of pain in the orofacial region is what in origin

A

inflammatory disease of pulpal origin

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2
Q

before treating a patient in pain, what is imperative

A

correct diagnosis is imperative

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3
Q

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

A

gate control theory

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4
Q

principles of gate control theory

A
  1. descending control mechanisms from higher central nervous centers
  2. cognitive, motivational and affective processes
  3. degree of activity in large-diameter and small diameter nerve fibers
  4. large diameter fibers are activated by non-noxious stimuli and close the gate
  5. small diameter fibers are activated by noxious stimuli and “open the gate”
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5
Q
A
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6
Q

Large diameter fibers are activated by
___ and ___.

A

non-noxious stimuli and “close the gate”

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7
Q

Small diameter fibers are activated by
___ and ___.

A

noxious stimuli and “open the gate”

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8
Q

what is pain perceived to originate from a site with no damage

A

referred pain

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9
Q

what theory occurs when afferent nerves converge on same second order neuron

A

referred pain convergence theory

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10
Q

what are possible sources of referred pain

A

muscles, ear, sinuses, heart, and other teeth

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11
Q

can muscles of mastication refer pain to teeth

A

yes

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12
Q

where do you palpate muscles of mastication

A

muscle insertions

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13
Q

what provides myofascial pain dysfunction syndrome?

A

TMD/muscles of mastication -> patients with these condition describe toothache as one of their symptoms

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14
Q

what is referred pain from respiratory mucosa to teeth

A

sinus pain

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15
Q

where does sinus pain deliver pain

A

posterior maxillary teeth

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16
Q

what dose sinus pain feel like

A

tender to mastication and hypersensitive to cold, tenderness to pressure on cheeks, pain worsened by lowering head and jumping on heels

17
Q

people with sinus pain have a history of what

A

history of respiratory infections and allergies

18
Q

what is referred pain from angina pectoris or myocardial infarction

A

cardiac origin

19
Q

which arch can perceive pain of cardiac origin?

A

EITHER arch! but left mandible is most common

20
Q

occasionally, cardiac pain is only felt where

A

face and jaws

21
Q

T/F: toothache is incapable of being referred to other teeth

A

FALSE! it is capable. there are many tooth pain referral patterns

22
Q

what commonly refers pain to the ear

A

mandibular molars

23
Q

as inflammatory mediators spread, can pain diffuse thru a wider area?

A

YES!

24
Q

what are types of spreading pain

A
  1. primary spreading pain
  2. secondary spreading pain (muscle)
  3. allodynia
25
Q

what is a pain due to a stimulus that does not normally provoke pain?

A

allodynia

e.g., light feather touch (that should only produce light sensation) causes pain

26
Q

what are other sources of orofacial pain

A
  1. psychogenic pain
  2. neuritis
  3. neuralgia
  4. atypical orofacial pain
27
Q

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
A

psychogenic pain

28
Q

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
A

psychogenic pain

29
Q

what is a tentative LAST RESORT diagnosis and indicates referral?

A

psychogenic pain

30
Q

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
A

trigeminal neuralgia

31
Q

are headaches capable of referring pain to teeth and viceversa?

A

YES

32
Q

types of headaches

A
  1. vascular headaches (migraine)
  2. cluster headaches
  3. tension headaches
33
Q

what questions to ask to diagnose pain

A
  • is pain of dental origin?
  • which tooth is it?
34
Q

you should always do what when doing pain diagnosis

A

always reproduce patient symptoms

35
Q

what to do with difficult pain diagnosis

A
  • provide symptomatic relief and observe patient
  • seek an expert opinion