Facial Pain Flashcards
Trigeminal neuralgia demographics
slightly more common in females
8 in 100,00 in uk incidence
peak incidence aged 50-60
Oxacarbazepine - how does it effects differ from carbamazepine
tends to be better tolerated
greater risk of lowering sodium levels
trigeminal neuralgia second line medications
lamotrigine
baclofen
gabapentin
pregablin
microvascular decompression - results
70% patients pain free up to 10 years
morality of 0.1%
significant in-patient stay
burning mouth disorder - definition
a chronic orofacial pain with an intraoral burning or dysaesthetic sensation that recurs for more than 2 hour a day on 50% of the days over more than 3 months
- without evident causative lesions on clinical investigation and examination
burning mouth disorder demographics
worldwide prevalence 1.7%
women > men
higher prevalence in older age groups
Burning mouth syndrome is a diagnosis of exclusion. what conditions do you need to exclude?
oromucosal diseases
- e.g. oral lichen planus
hypo salivation
tongue parafunction
anaemia
vitamin b12 and b9 deficiency
diabetes mellitus
use of ACE inhibitors
burning mouth disorder - symptoms
pain of a burning quality affecting the mouth lining
often tongue is the focus
can affect multiple sites
may be associated xerostomia or dysgeusia
often bilateral presentation
often relieved with eating
often worsen as day progresses
burning mouth syndrome onset
in approx half = spontaneous
in approx third - trigger factor
can have periods of remission
burning mouth syndrome - common triggers
dental procedures
medical procedures
new medications
illness
stressful life events
burning mouth syndrome - psychology
often associated emotions distress
- anxiety and depression common findings
psychological factors correlation is no more pronounced than any other chronic pain entities
BMS treatment in secondary care
education and reassurance
alpha lipoic acid
- likely a placebo
avoid benzydamine
CBT
clonazepam topically 500mcg tablet crushed with water
nortriptyline up to 50 mg
gabapentin or pregablin
duloxetine
persistant idiopathic facial pain - symptoms
poorly localised unilateral pain
- can present bilaterally
usually maxillary region affected
described as dull, nagging, aching, throbbing
can be sharp exacerbations
persistent and daily
aggravated by stress
Persistant idiopathic facial pain - onset
frequently follows minor procedure
often patients can’t remember sequence of events
further intervention by dentist can aggravate pain
persistent idiopathic facial pain management
avoid unnecessary dental treatment where diagnosis uncertain
consider differential
refers to oral medicine
persistent idiopathic facial pain secondary care management
nortriptyline
duloxetine
CBCT
distraction
relaxation
physiotherapy
physical activity
persistent idiopathic dentoalveolar pain definition
persistent unilateral intraoral dentoalveolar pain, rarely occurring in multiple sites, with variable features but recurring daily for more than 2 hours per day for more than 3 months
in the absence of preceding causative event
persistent idiopathic dentoalveolar pain symptoms
well localised moderate intensity pain
any tooth or mucosa of extraction site
most commonly premolar or molar regions of maxilla
character - dull, pressure like
difficult to distinguish from odontogenic pain
persistent idiopathic dentoalveoler pain - onset
association with preceding dental treatment
persistent idiopathic dentoalveoler pain - how to rule out odontogenic pain
normal clinical and radiographic examinations
continuous pain reported unlike pulpal pain which tends to either worsen or improve with time
does not wake patient from sleep
previous dental treatment without improvement to pain
pain may affect adjacent teeth following dental treatment
pain aggravated by stress
potential involvement of multiple sites in different quadrants
persistent idiopathic dentoalveoler pain - how to manage in general practice
pause
careful history taken
investigate
- radiographs, sensibility testing
refer to oral med or restorative
post traumatic trigeminal neuropathic pain definition
persisting for over 3 months
onset within 6 months of injury to the peripheral trigeminal nerve
associated with somatosensory symptoms in the area of burning, shooting pain or numbness
associated with hyperalgesia and allodynia
post traumatic trigeminal neuropathic pain precipitating injuries include:
third molar surgery
extractions
implant placement
endodontic treatment
administration of LA
post traumatic trigeminal neuropathic pain symptoms
burning or shooting pain
moderate to severe intensity
usually continuous , lasting most of the day
rarely crosses midline
