Facial pain: Intro and dental pain Flashcards
What is the most common facial pain?
Dental pain
Causes of dental pain?
Teeth: Caries/exposed dentine Pulpal pain Periapical pain Cracked tooth syndrome
Gingiva:
Periodontitis
Pericoronitis
Malignancy
Bone:
Osteomyelitis
Post op pain
Referred dental pain
How to take a pain history?
Location
- Deep/superficial/skin
- In the tooth
- In the bone/under tooth
Radiation - to other structures Duration - How long present - When did it begin - Following RTA/RCT - Previous episode
Onset
- What sets it off
- Is it there when pt wakes
- Wake pt up?
- Does it gradually appear through the day?
- Is it there only with certain activities?
Characteristics
- Sharp, shooting, throbbing, aching, burning
- Intensity - mild, mod, severe, score
- Qual, frequency/duration, intensity, associated symptoms
- Constant, intermittent, now and then, sudden
Aggravating/alleviating factors - func/parafunc activities
- Hot/cold
- Sleep disturbance
- Analgesic usefulness
- Relationship to stress
Past consults and tx
Associated symptoms
- Clicking
- Tearing
- Facial flushing
- Swelling
Epidemiology of chronic facial pain?
7-14% of the population
Consequences of chronic pain?
Reduced activity - muscle wasting, joint stiffness
Depression, irritability
Tx failures = depression
Long term use of analgesics and sedatives = side effects
Loss of job, stress
What becomes very important with chronic pain?
FH and SH
What to examine?
E.O Symmetry Lymph nodes TMJ Cranial nerves
I.O
Soft tissues
Teeth
S.T
Imaging
Vitality testing
Laboratory
Palpate and percuss
How to establish a diagnosis?
History
Exam
Special tests
= Diagnosis = Tx options
Acute pulpitis features?
Difficult to localise Changes with time Hypersensitive to stimuli Poor response to analgesics Vital
Types of acute pulpal pains?
Acute pulpitis
Cracked tooth syndrome - worsened by biting
Hypersensitivity - in response to cold/sweet
Periapical periodontitis features?
Localised
Painful to bite
Non-vital
Periodontal pains?
Periapical periodontitis
Periodontal abscesses
Lateral periodontal lesions
Trauma - direct trauma, ortho tx, bruxism - several teeth
Osteitis features?
Dry socket - acute alveolitis Osteomyelitis/BRONG/MRONJ Deep throbbing pain Difficulty sleeping Frequent bad taste Foul odour Paraesthesia: pathognomonic of osteomyelitis
Post op pain features?
Inflammatory pain Mediated by AA pathway Good surgical technique can minimise NSAIDs 3rd molar model - analgesic trials
Referred dental pain features?
Fairly common for headache
Referred from another quadrant
Cardiac tooth pain - rare
Sinusitis
Maxillary sinusitis symptoms?
Constant burning pain with zygomatic and dental tenderness from the inflammation of the maxillary sinus
C/O Purulent rhinorhea
Recovery from a nasal cold and then a worsening of symptoms
O/E purulent secretions in the nasal cavity
ESR (erythrocyte sedimentation rate) above 10mm per hour
What does nasal sinus functioning depend on?
Patent ostia
Satisfactory ciliary functioning
Appropriate amount of secretions
Oral dysaesthesia?
Aetiology unknown Exclusion initially Management - CBT improved 6/12 Oestrogen increased taste Prognosis unknown
What is trigeminal neuralgia?
A sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve
Atypical facial pain symptoms?
Present daily and persists for most or all of the day
Should be confined at onset to a limited area of one or both sides of the face, but may spread to the upper of lower jaws and a wider area of the face and neck
Should NOT be associated with sensory loss or other physical signs
Lab investigations should not demonstrate relevant abnormalities
Pain may be initiated by trauma but persist without any demonstrable local cause
Atypical odontalgia symptoms?
Severe throbbing pain in the tooth without major pathology
Temporomandibular joint pain causes?
Costens syndrome TMJ dysfunction syndrome Myofascial pain syndrome Facial arthromyalgia Oromandibular pain
TMJ pain symptoms?
Pain in the TMJ and muscles of mastication, which may worsen upon chewing, possibly leading to restricted jaw movement
