Ch 18 - Orofacial Pain 2 Flashcards
What are the 2 alternate names for Giant Cell Arteritis?
- Temporal arteritis
2. Granulomatous Arteritis
What is the most common site for giant cell arteritis?
temporal artery (hence the term temporal arteritis)
What is a common HLA type for patients with giant cell arteritis?
HLA-DR4 (samesies as Heck Disease)
giant cell arteritis:
two ethnic groups
age group
gender
Scandinavian or Northern European…avg age 70 (rarely under 50)..females 2x as often
What is the term for the giant cell arteritis symptom causing cramping pain in the masseter and temporalis?
jaw claudication
What oral artery can be involved by giant cell arteritis and what is the consequence?
lingual artery - uni or bilateral tongue necrosis :0
What is the most significant complication of giant cell arteritis in the head and neck region?
vision loss (vasculitis of the posterior ciliary artery)
What % range (LOL a BIG one) of patients with giant vell arteritis have vision loss?
14-70%
What is the term for aching pain and morning stiffness in the neck, shoulders, and pelvic girdle sometimes seen in giant cell arteritis patients?
polymyalgia rheumatica
What % of giant cell arteritis patients are affected in the aorta?
50%
Biopsy of the temporal artery is the gold standard for diagnosis of giant cell arteritis - how much tissue due you need for adequate dx? What are 5 key features on histology?
1cm of affected vessel
- chronic inflammation of the tunica intima, tunica media
- narrowing of lumen from edema and proliferation of the tunica intima
- necrosis of the smooth muscle and elastic lamina
- giant cells
- thrombosis / occlusion
What 3 clinical lab values help diagnose giant cell arteritis?
- elevated ESR
- increased C reactive protein
- Elevated platelet count
What are the typical treatments for giant cell arteritis?
- high-dose systemic steriod
2. chronic: methotrexate or azathioprine added for steroid-sparing effects
You ready? What are the 6 names for burning mouth disorder?
- Burning mouth syndrome
- Burning tongue syndrome
- Glossodynia (dynia = anguish)
- Glossopyrosis (pyrosis = fire)
- Stomatodynia
- Stomatopyrosis
What do 2/3 of BMD patients describe their dysgusia as?
“metallic taste”
What two areas of the oral cavity, besides the tongue, are most often affected in BMD?
Anterior hard palate and labial mucosa
BMD by the numbers:
- what % range of adults? postmenopausal women?
- Two ethic groups at higher risk? Two ethnic groups at lower risk comparativly?
- age?
- gender?
- 0.7 - 15% of adults to some degree (12.2% postmenopausal women)
- Asians and Native Americans at higher risk…whites/blacks at lower risk
- especially after 55 years of age, 3-12 years post menopause
- women 4-7x more likely
What region of the dorsal tongue is most often the sight of burning in BMD?
Anterior 2/3s
Do BMD typically present with xerostomia?
they complain of xerostomia, but normal salivary levels usually measured
What is a common complaint of BMD patients in regard to the time of day and intensity of symptoms?
mild discomfort on awakening with increasing intensity throughout the day
Do BMD symptoms typically interfere with sleep?
no
BMD: what does contact with hot food or liquid do to symptoms?
often intensifies
Evidence from randomized controlled trials suggests which medication should be deployed as first line therapy in patients with BMD?
Clonazepam