Final: Dental and Orofacial Pain Flashcards
how common is sinusitis in the US and toothache related?
12% of US population has sinusitis and 10% of people with sinusitis report maxillary toothache
-maxillary nerve (mddle branch of trigeminal nerve) splits off from sinus region and breaks into posterior superior alveolar nerve, middle superior alveolar nerve, and anterior uperior alveolar nerve which supply maxillary teeth
how common is it for sinus pain vs odontogenic pain to experiece : tender to tapping/percusion?
both will experience pain (often) for this
how common is it for sinus pain vs odontogenic pain to experiece : cold sensitivity?
both will experience it often
how common is it for sinus pain vs odontogenic pain to experiece :intraoral mucosal tendernous, edema and erythema?
both will experience this SOMETIMES with sinus/ tooth pain
how common is it for sinus pain vs odontogenic pain to experiece : worsen pain when bending forward
sinus: OFTEN
odontogenic: SOMETIMES
how common is it for sinus pain vs odontogenic pain to experiece : recent history of cold/flu/allergies
Sinus: USUALLY, odontogenic: sometimes
how common is it for sinus pain vs odontogenic pain to experiece : nasal /sinus symptoms
sinus: USUALLY, odontogenic: sometimes
how common is it for sinus pain vs odontogenic pain to experiece : multiple teeth involved
sinus: USUALLY
odontogenic: RARELY
how common is it for sinus pain vs odontogenic pain to experiece : relief with injected anasthetic
sinus: NOINE to partial
odontogenic: usually complete relief
how common is it for sinus pain vs odontogenic pain to experiece : foul odor or taste
sinus: SOMETIMES, odontogenic: SOMETIMES
how common is it for sinus pain vs odontogenic pain to experiece : large dental lesion
sinus: never
odontogenic: usually
what are the most common dental causes for sinus pain? other less common ones?
MOST:
- pariapical abscess
- periodontal disease
- dental extraction
- foreign body in sinus
others:
- osteomyelitis
- endodontic instrumentation
- over-obturation
- incorrectly positioned implant
- incorrectly performed sinus augmentation
what can be odontogenic sinus infections side effects
- polyps
- mucous retention cyst (treatment not always recommended but could get large)
- mucocoele (could cause bony expansion)
- -OROANTAL FISTULA : most common OMFS omfs related sinus complication
what is the most common OMFS related sinus complication? what is it usually due to usually?
-what can it result in?
OROANTRAL FISTULA
- 80% are due to maxillary posterior tooth extraction
- results: chronic rhinosinusitis, purulent discharge through fistula, especially with drinking or blowing nose
how will oroantral fistulas self close
- oral epithelium
- granulation tissue
- polyps of sinus mucosal membrane
how will oroantral fistula be closed surgically
- direct closure
- flaps
- buccal fat pad
- absorbable membranes
how do you treat a odontogenic maxillary sinusitis?
- resolve offending dental infection
- sinus treatment : irrigation/decongestants
where does dentinal hypersnsitivity tend to occur
in the less obvious recession areas ?
what will usually be present with odontogenic pain and if not how can you find out
explanatory lesion (or pulp testing can detect it. hypersensitivity is often in less obvious recession areas)
what is usually present with periodontal pain? if you can’t tell, what methods can rule it out?
usually its visible, but if its not clear , SRP and chlorhexidine are simple, safe and conservative methods for ruling it out
what causes neuropathic pain?
dysfunction of neurons
- usually no physical alteration of the neurons!! so no visible findings or lesions!!
- almost always results in multiple diagnoses and mistreatment
who manages neuropathic pain and what role does dentist play
orofacial pain or neurology!
-dentist plays important role in diagnosis: knowing what a healthy mouth looks like (dental clinical exam and radiograph exam), knowing what symptoms each dental condition could case, intraoral anesthesia?
how to go about dental procedures with neuropathic pain
- only perform necessary
- explain pain may worsen, usually temporary
- consider preemptive NSAIDs
- profound anaesthesia
what can occur occlusally due to arthritis
- posteriors may wear on occlusals to compensate
- teeth may compensate too slowly as more teeth become involved
Right side dejenerative joint diseaes on TMJ : what will occur atnerior, right posterior/left posterior and symptoms?
- anterior: hypo-occlusion or open bite. possible madibular midline shift to the right.
- right posterior: hyper-occlusion on posteriormost tooth.
- left posterior: normal or hypo-occlusion
symptoms: Right TMJ may be painful!
Bilateral DJD tmj: anterior, right posterior and left ? symtpoms
anterior: hypo-occlusion or open bite
right posterior: hyper occlusion on posteriormost tooth
left posterior: hyper occlusion on posteriormost tooth
symptoms: bilateral TMJ may be painful
what can cause temporary occlusion alteration
spasm (injury, long dental procedure..)
what can cause permanent malocclusion
fixed prosthodontics or occlusal equilibration (fixing occlusion by adjusting teeth)
what can a right lateral pterygoid spasm cause anterior, right posterior, left posterior and symptoms?
anterior: early contact between teeth
right posterior: hypo-occlusion!!!!
left posterior: normal
painful right lateral pterygoid is symtpom!
bilateral lateral pterygoid spasm- anterior, r/l posterior and symtpoms?
anterior: early contact
right and left posteriors: hypoocclusion
symptoms: painful bilateral lateral pterygoid
what is capsulitis/synovitis
tmj swelling
what can right capsulitis/synovitis lead to for anterior, right post, left post and symptoms
anterior: normal (midline shift usually imperceptible)
right posterior: HYPOOCCLUSION!
left posterior: normal
symptoms: painful right tmj
what is edentulous
lacking teeth
what occurs to occlusion with severe periodontal disease or edentulous
- muscles and ligaments tighten with shorter resting length (due to shorter VDO- vertical dimension of occlusion)
- muscles and ligaments tighten with shorter maximum opening due to a liquid diet (?)
treatment; gentle and regular stretches
what types of prolonged/intense forces can cause TMD
wide opening, long dental appointments
