Facial pain: Intro and dental pain

Question 1

What is the most common facial pain?

Answer 1

Dental pain

Question 2

Causes of dental pain?

Answer 2

Teeth:
Caries/exposed dentine
Pulpal pain
Periapical pain
Cracked tooth syndrome

Gingiva:
Periodontitis
Pericoronitis
Malignancy

Bone:
Osteomyelitis

Post op pain
Referred dental pain

Question 3

How to take a pain history?

Answer 3

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

Question 4

Epidemiology of chronic facial pain?

Answer 4

7-14% of the population

Question 5

Consequences of chronic pain?

Answer 5

Reduced activity - muscle wasting, joint stiffness
Depression, irritability
Tx failures = depression
Long term use of analgesics and sedatives = side effects
Loss of job, stress

Question 6

What becomes very important with chronic pain?

Answer 6

FH and SH

Question 7

What to examine?

Answer 7

E.O
Symmetry
Lymph nodes
TMJ
Cranial nerves

I.O
Soft tissues
Teeth

S.T
Imaging
Vitality testing
Laboratory

Palpate and percuss

Question 8

How to establish a diagnosis?

Answer 8

History
Exam
Special tests
= Diagnosis = Tx options

Question 9

Acute pulpitis features?

Answer 9

Difficult to localise
Changes with time
Hypersensitive to stimuli
Poor response to analgesics
Vital

Question 10

Types of acute pulpal pains?

Answer 10

Acute pulpitis
Cracked tooth syndrome - worsened by biting
Hypersensitivity - in response to cold/sweet

Question 11

Periapical periodontitis features?

Answer 11

Localised
Painful to bite
Non-vital

Question 12

Periodontal pains?

Answer 12

Periapical periodontitis
Periodontal abscesses
Lateral periodontal lesions
Trauma - direct trauma, ortho tx, bruxism - several teeth

Question 13

Osteitis features?

Answer 13

Dry socket - acute alveolitis
Osteomyelitis/BRONG/MRONJ
Deep throbbing pain
Difficulty sleeping
Frequent bad taste
Foul odour
Paraesthesia: pathognomonic of osteomyelitis

Question 14

Post op pain features?

Answer 14

Inflammatory pain
Mediated by AA pathway
Good surgical technique can minimise
NSAIDs
3rd molar model - analgesic trials

Question 15

Referred dental pain features?

Answer 15

Fairly common for headache
Referred from another quadrant
Cardiac tooth pain - rare
Sinusitis

Question 16

Maxillary sinusitis symptoms?

Answer 16

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

Question 17

What does nasal sinus functioning depend on?

Answer 17

Patent ostia
Satisfactory ciliary functioning
Appropriate amount of secretions

Question 18

Oral dysaesthesia?

Answer 18

Aetiology unknown
Exclusion initially
Management - CBT improved 6/12
Oestrogen increased taste
Prognosis unknown

Question 19

What is trigeminal neuralgia?

Answer 19

A sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve

Question 20

Atypical facial pain symptoms?

Answer 20

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

Question 21

Atypical odontalgia symptoms?

Answer 21

Severe throbbing pain in the tooth without major pathology

Question 22

Temporomandibular joint pain causes?

Answer 22

Costens syndrome
TMJ dysfunction syndrome
Myofascial pain syndrome
Facial arthromyalgia
Oromandibular pain

Question 23

TMJ pain symptoms?

Answer 23

Pain in the TMJ and muscles of mastication, which may worsen upon chewing, possibly leading to restricted jaw movement