Facial Pain Flashcards
What aspects of pain history are important in facial pain? (7)
- Timing: onset, duration and periodicity
- Location and radiation
- Quality and severity
- Relieving and aggravating factors
- Associated factors
- Other pain conditions
- Impact of pain
What questionnaires are used in assessing facial pain?
- Brief Pain Inventory
- Beck Depression Inventory
- Hospital Anxiety and Depression Scale
- McGill Pain Questionnaire
- Oral Impacts on Daily Performance
When are laboratory investigations important in facial pain?
For cranial arteritis and auto-immune disorders.
What imaging is used to investigate facial pain?
- X-rays
- OPG – bony lesions and cysts
- Ultrasound – salivary glands
- MRIs and CBCT
How would you know acute facial pain has a dental or oral cause?
Most likely unilateral and located within the mouth.
What causes maxillary sinusitis-related facial pain?
- Acute and chronic form unlikely to be associated with pain
- Most frequently caused by viruses or bacteria, but can occur after dental infection or after treatment to upper premolars/molars
What are common causes of salivary gland pain?
- Tumours
- duct blockages
- infection
- salivary stones.
Where are salivary stones most frequent
Salivary stones most frequent in submandibular gland
what type of pain suggests salivary gland tumours
- Pain intermittent and occurs just before eating
- Salivary flow will be slow or absent
What is the most common non-dental cause of facial pain?
TMJ disorders (TMJD).
How can a salivary stone be located
Bimanual palpation enables stone to be located
What psychological factors increase the risk of chronic TMJD?
- Depression
- catastrophising
- other psychological factors.
What is TMJD linked with
Linked with back pain, fibromyalgia and headaches
What is the most common form of acute TMJD?
Prolonged opening (e.g., during treatment or trauma).
what is limited opening defined as
Limited opening defined as <40mm
How is TMJD managed?
Reassurance, soft diet, analgesics, occlusal guard, and possibly amitriptyline.
What drug interventions for TMJD
Amitriptyline may have some benefit, no benefit of Botox in RCTs
What is trigeminal neuralgia?
Sudden, unilateral severe stabbing pain in the distribution of one or more branches of the trigeminal nerve.
What symptom can differentiate trigeminal neuralgia from dental pain?
It does not disturb sleep.
Pts may complain about pain on shaving
What is the most common cause of trigeminal neuralgia?
Neurovascular compression of the trigeminal nerve in or around route of entry zone whereas type 2 might be more central
What condition should be suspected in a young patient with trigeminal neuralgia?
Multiple sclerosis (needs MRI).
What is the treatment in severe cases
Surgery is an option in severe cases however most patients are pain free within 5-10y
What is glossopharyngeal neuralgia?
Similar to trigeminal neuralgia but with pain in the ear and posterior tongue, triggered by swallowing.
How is glossopharyngeal neuralgia managed
same as trigeminal neuralgia
What are symptoms of giant cell arteritis?
Unilateral pain, severe headache, and swelling of the temporal artery.
What is the most serious consequence of untreated giant cell arteritis?
Blindness.
What is the management for giant cell arteritis?
Immediate referral for systemic steroids.
What is persistent idiopathic facial pain (PIFP)?
Facial pain that does not fulfil any specific diagnostic criteria.
- often a history of other chronic pain, poor coping skills, and mood disturbance
How is persistent idiopathic facial pain managed?
Antidepressants combined with cognitive behavioural therapy (CBT).
How does PIFP differ from trigeminal neuralgia?
No trigger points and a dull ache rather than sharp pain.
and quality of pain
What might a progressive headache indicate?
Subarachnoid haemorrhage.
symptoms suspicious of giant cell arteritis
Unilateral pain, severe headache, swelling of temporal artery
