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
What fraction of patients with BMD have resolution of symptoms over the span of months or years?
1/3 - 1/2
What are the two alternate names for dysgeusia and hypogeusia?
- Phantom taste 2.Distorted taste
What are most cases of dysgeusia produced by or associated with?
- underlying systemic disorder
2. radiation therapy to the head and neck
What a likely underlying cause of hemiageusia? (loss of taste to only half the tongue)
ischemia/infarction of the brainstem
How many drugs are known to cause taste disturbances?
more than 200
What % of patients with clinical depression complain of dysgeusia?
40%
What are three local entities that clinicians should rule out as a cause of dysgeusia before considering systemic factors?
- abscess (perio or endo) 2. candidiasis 3. gingivitis/periodontitis
For diagnosing dysgeusia: the clinician must be certain that the patient’s alteration is, in fact, a taste disorder rather than an olfactory one, because WHAT % of “flavor” information (e.g., taste, aroma, texture, temperature, and irritating properties) is derived from SMELL.
75%
What is the term for dysgeusia that occurs without a stimulus?
phantom taste
What fraction of dysgeusia patients experiecnce spontaneous resolution? How long does it take?
2/3 of patients, avg time 10 months
What is an alternate name for osteoarthritis?
degenerative joint disease
OA is almost universal in people over what age?
65
OA accounts for approximately WHAT % of patients evaluated for TMJ pain?
10%
What is the change in pain throughout the day for OA?
gradual intensification, worse in the evening than the morning
What are some treatment options for OA of the TMJ?
- analgesics/NSAIDS
- hot/cold packs
- occlusal splint
- lavage
- Glucosamine/chondroitin sulfate
- doxycycline
What HLA locus has long been identified as the most significant genetic association for the development for RA?
HLA-DRB(beta)1
What % of Americans are affected by RA? What % range of RA patients have TMJ involvment?
2-2.5%…50-75% (usually mild and clinically insignificant)
What is the term for a reactive, macrophage-laden fibroblastic proliferation seen from the synovium to the joint surface in RA?
pannus
RA: gender and age
affects women 3x more than men, but men diagnosed younger than women (25-35 years men, 35-45 years women)
What is the classic look for the hands and the fingers for RA?
hands = ulnar deviation
fingers = swan neck deformities
What are the pathognomonic findings in the skin near the affected joint in RA?
Rheumatoid nodules (20% of patients)
What is the characteristic shape of joints affected by RA?
“anvil” shaped
When the TMJ is affected in RA, what are the characteristics?
often bilateral, occurs late in the clinical course
What can gross destruction of the condylar heads in RA do to a patient’s occlusion?
can develop class II, anterior open bite
What is the specific serological marker for RA?
ACPAs (anti-citrullinated protein antibodies)
80% of RA patients will have significant elevations in which serologic marker?
RF (rheumatoid factor)
Which antibody is targeted by RF?
IgG
Which serological marker is detected in 50% of patients with RA, but is not very specific?
ANAs (antinuclear antibodies)
What blood value is elevated in 90% of RA patients during flare ups (active phase)?
ESR (not specific, but can monitor the clinical course of the disease)
What is the histological buzzword for the findings of RA?
RICE BODIES - Typically, the membrane protrudes into the joint space as villi or fingerlike projections. These projections occasionally undergo necrosis, producing rice bodies—small whitish villi fragments composed of cellular debris admixed with fibrin and collagen
What is the most frequently used disease modifying agent used for RA?
methotrexate (a folic acid inhibitor)
TMD age and gender
primarily young and middle-aged women (but may affect any age and sex)
What is the term for a painful response to a non-painful stimulus?
allodynia
What are 3 inflammatory conditions frequently co-morbid with TMD?
- Lupus
- RA
- Systemic sclerosis
What are 3 inflammatory conditions frequently co-morbid with TMD?
- Lupus
- RA
- Systemic sclerosis
