Facial pain

Question 1

How can you assess a patient pain

Answer 1

Physical symptoms
-PAIN scores (McGill)

Emotional symptoms
-Psychological scores (HAD)

QOL scores (OHIP)

Question 2

How is pain felt

Answer 2

Nociception

Peripheral Nerve Transmission

Spinal Modulation

Central Appreciation

Question 3

Cardiac pain can refer to where

Answer 3

Left shoulder

Under breast bone

Down arm

Below ribs

Right shoulder

Pain up to the neck, jaw and teeth

Question 4

What is CRPS

Answer 4

Chronic Regional Pain

Delocalised pain
that spreads around ‘anatomical’ boundaries, may appear bilateral,
‘gripping’, tight, burning pain

Question 5

What is the sensory somatic nerve supply of the face

Answer 5

V, VII, IX, X & Cervical 1-3

Question 6

What is nociceptive pain and give examples

Answer 6

Cause by the activity in neural pathways i response to potentially tissue damaging stimuli

-Arthritis
- Mechanical lower back pain
- Sport injuries

Question 7

What is neurpathic pain and give example

Answer 7

Pain initiated or caused by primary lesion or dysfunction in the nervous system

-CRPS
- trigeminal neuralgia
- Central post stroke pain
- Spinal cord injury

Question 8

What is neuropathic pain like

Answer 8

Constant burning/aching pain

Fixed location

Often a fixed intensity

Question 9

What are the 2 most common forms of neuropathic pain

Answer 9

Post-herpetic neuralgia

Diabetic peripheral neuropathy

Question 10

What can cause neuropathic pain

Answer 10

Usually follows an injury

Can follow an extraction

Can follow Herpes Zoster (Shingles) episode
-Post Herpetic Neuralgia

Question 11

How do you manage nueropathic pain

Answer 11

Systemic medication
-Pregabalin
-Gabapentin
-Tricyclic
-Duloxetine

Topical medication
-Capsaicin
-EMLA
-Benzdamine
-Ketamine

Question 12

How does the systemic management of neruopathic pain work

Answer 12

They don’t stop the pain they but they reduce the afferent info to the CNS so slowing down pain signalisation

Question 13

What physical and psychological management of neuropathic pain is there

Answer 13

Physical
-TENS
-Acupuncture

Psychological
-Distraction
-Correct abnormal illness behaviour
-Improve self esteem/positive outlook

Question 14

What is atypical Odontalgia and what is the pattern of the pain

Answer 14

Dental pain without dental pathology

It has a distinct pattern of pain
-Equal sex distribution
-Pain free or mild between episodes
-Intense unbearable pain of 2-3 weeks duration that Settles spontaneously

Question 15

If a patient presents with you with pain that you suspect is atypical odontalgia what do you do

Answer 15

If after all Tx the pain still persists perform an aesthetic test

If pain relieved= perform tests for peripheral or central sensitisation

If pain persists= Order MRI of brain and refer patient to appropriate specialist

Question 16

What is oral dysaesthesia

Answer 16

Abnormal sensory PERCEPTION in ABSENCE OF ABNORMAL STIMULUS

Question 17

What modes of oral sensation is involved in oral dysaesthesia

Answer 17

Burning or ‘nipping’ feeling

Dysgeusia

Paraesthesic feeling

Dry mouth feeling

Question 18

What can be predisposing factors for oral dysaesthesia

Answer 18

Deficiency states
-haematinics
-zinc
-vit B1, B6

Fungal and Viral infections

Anxiety and stress

Gender – more women present to OM than men

Question 19

What oral dysaesthesia is most likely if the patient has a haematic deficiency

Answer 19

Burning

Question 20

if the patient has a parafunction or tongue thrust where is the burning oral dysaesthesia most liely to be

Answer 20

Lips and tongue tip/margin

Question 21

What is dysgeusia

Answer 21

A bad taste/bad smell/Halitosis

Question 22

What is the most common oral dysaesthia

Answer 22

Dry mouth dysaesthesia

Question 23

How do you manage dysaesthesia

Answer 23

Explain the condition to the patient

Assess degree of anxiety

Anxiolytic based medication
-Nortriptyline
-Mirtazepine
-Vortioxetine

Neuropathic Medication
-Gabapentin/Pregabalin
-Clonazepam

Question 24

If a patient is complaining of TMJ pain what is a sign that it does not involve the joint

Answer 24

When patient points to the pain they use multiple fingers or the palm of there hands to show instead of pointing directly to TMJ

Question 25

What are the physical signs of TMD

Answer 25

clicking joint

locking with reduction

limitation of opening mouth

tenderness of masticatory muscles

tenderness of cervico-cranial muscles