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Acute orofacial pain Flashcards

1
Q

What are the causes of facial pain?

A

Local disease

Neurological pain

Vascular pain

referred pain

Physchogenic pain

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2
Q

What questions should be asked in a detailed pain history?

A

SOCRATES

Site

Onset

Character

Radiation

Associating factors

Time

Exacerbating factors

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3
Q

What are the local causes of orofacial pain?

A

Teeth

Supporting tissues and mucosa

sinuses

salivary glands

TMJ

Intercranial pressure

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4
Q

what are the causes of odontogenic pain?

A

Dentinal

Pulpal

periodontal

Absess

Periapicle

Pericoronal

gingival

Mucosal

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5
Q

what type of pain is dentinal pain?

A

Sharp

Provoked

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6
Q

What are the symptoms of pulpal pain?

A

pooly localised

Throbbing

Spontaneous

exacerbated by temperature chance

May be worse on lying down

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7
Q

What are the symptons of periodontal pain?

A

Less severe

Localised

Associated mobility

More tender to lateral pressure than vertical pressure

Lateral periodontal absess- Well localised pain with pus,

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8
Q

Symptoms of acute apical periodontitis?

A

Long lasting, sever spontaneous pain

Well localised

Exacerbated on biting

vestibular tenderness +- facial swelling

May have sinus at apical level

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9
Q

What causes an absess and where can it spread?

A

May be a result of apical, periodontal or combined disease (Perioendo lesion)

Infection will follow the path of least resistance in order to drain, When the periosteum has been breached then pus will track into the adjacent tissue spaces. This can present as a fat face or trismus

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10
Q

How do you treat purulent infections?

A

DRAINAGE

Antimicrobials should only be used as an adjunct and can be used for two reasons

  • Limit the spread of local infection
  • Prevent metastatic spread of
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11
Q

What are the symtoms of systemic infection?

A

Raised temperature (axilla 36.8 degrees Celcius) indicated raised endotoxin (powerful mediators of temperature regulation)

Regional lymphadenopathy

uncontrolled or spreading of swelling

trismus

malaise

medically compromised patients

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12
Q

What dosage and lenght should you give when prescribing antimicrobials?

A

Lowest does possible should be used for the shortest possible time.

Antimicrobail therapy should be stopped once systemic

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13
Q

What are the guidelines for antimicrobials for an acute dentoalveloar infection?

A
  1. Amoxicillin 250mg tds for 3 days then r/v
  2. Metronidazole 200mg tds for 3 days then r/v
  3. Clindamycin 150mg qds for 3 days then r/v
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14
Q

What are the antibiotic guidlines for PERICORONITIS, ACUTE PERIODONTAL ABSCESS ANUG (anaerobic infections)?

A

. Metronidazole 200mg tds for 3 days

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15
Q

What are the indications for antibiotics for ORO-ANTRAL FISTULA or ACUTE MAXILLARY SINUSITIS

A
  1. Amoxicillin 250mg tds for 5 days
  2. Doxycycline 200mg initial dose, then 100mg od for 5 days

Immunocomprismised patient may need more radical treatment

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16
Q

What are the symptoms of pericoronal infection?

A

Can be assoiciated with not fully erupted teeth.

Consider NICE guidlines for wisdom teeth removal.

spontaneous pain and increased on biting.

May need XLA of teeth

Irrigate and debride under operculum

17
Q

What are the symptpms of ANUG?

A

– Gram –ve smell,

  • loss of interdental papillae,
  • classically young male smoker
18
Q

What are the symptoms and treatment of Primary Herpetic Gingivo-Stomatitis?

A

1 st exposure to HSV,

usually in children / adolescents,

oral vesicles which break down to produce irregular painful ulcers.

TX- Self-limiting, analgesia, antipyretics, consider antivirals

19
Q

What are the symptoms of a cracked tooth, how do you diagnose and what is the treatment?

A

Pain is often severe, exacerbated by biting and often precipitated by thermal stimuli.

 Diagnosis can be made with a tooth sleuth or removal of the restoration and examination with high intensity light for fracture lines.

 Treatment is usually XLA

20
Q

What symptoms can occur with sinus pain?

A

Tooth located near antrum may be TTP.

Facial nerve palsy can signify malignancy- May infiltrate CNV

21
Q

What can cause salivary gland pain?

A

Bacterial

 Viral

 Sialoliths

 Strictures

 Tumours

22
Q

What can cause TMJ pain?

A

 Trauma

 Dislocation

 #

 Effusion

23
Q

What can pain in bone be from?

A

Dental Infections

 Osteomyelitis

 BRONJ

 Malignancies

 Infected cysts etc

 Paget’s disease

 Trauma

24
Q

What are the intracranial causes of pain?

A

 Headache

 Migraine

 Migraneous neuralgia

 V neuralgia

 M.S.

 Space Occupying Lesions (Benign & Malignant

Oral med (18 decks)

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