L10 - Odontogenic and Non odontogenic pain

Question 1

what is odontogenic pain

Answer 1

• tooth pain
• originates from tooth or surrounding periodontal structures
• originates from a dental pathology
• has a typical dental history profile of endo or perio pathology
• direct testing and manipulation usually reproduces symptoms

Question 2

what are the pulpal nociceptors

Answer 2

• A-beta
• A- delta
• C fibers

Question 3

where are the nociceptors located

Answer 3

• periapical
• osseous
• sinus nociceptors

Question 4

how is tooth pain mitigated

Answer 4

• treatment and medication
• pulpotomy, pulpectomy
• I and D to drain abscess
• analgesics for pain
• AB for infection with swelling/fever

Question 5

what is referred pain caused by

Answer 5

the convergence of multiple primary afferent nerve fibers into single second order projection fiber in the medullary horn

Question 6

what is hypersensitivity due to

Answer 6

an increase in local neural activity or due to increased stimulation (reduced threshold) of secondary nerve fibers centrally due to a barrage of primary fiber stimulation (central sensitization)

Question 7

what nerve transmits tooth pain

Answer 7

the trigeminal nerve

Question 8

what is allodynia

Answer 8

pain to what would normally be a non painful stimulus

Question 9

where can referred pain be found

Answer 9

maxillary molar pain referred to mandibular tooth and jaw

Question 10

what are examples of hypersensitivity

Answer 10

• exaggerated cold response
• other teeth also very sensitive to percussion
• pulpal testing

Question 11

what are examples of allodynia

Answer 11

• severre percussion sensitivity
• adjacent tooth percussion sensitivtiy
• sun burn sensitivity

Question 12

what is the tx for abscessed teeth

Answer 12

pulpectomy
- Ca(OH)2
- I and D

Question 13

what is the prescription for analgesics

Answer 13

• IBU 400mg q6h
• acetominophen 1000mg q6h

Question 14

what is the “triple whammy” in primary care

Answer 14

ACE inhibitor/ARB + diruetic and NSAID

Question 15

what percentage of pain is resolved with endo

Answer 15

90%

Question 16

what is 10% of persistent pain after endo tx from

Answer 16

• 5% untreated canals, fractures, persistent infection
• 5% neuropathic, neurovascular

Question 17

apical fenestration may occur in _____ of cases and may be considered an anatomic predisposing factor for:

Answer 17

9%; persistent pain after root canal treatment

Question 18

______ of americans have experienced at least one of five types of facial pain

Answer 18

22%

Question 19

of the 22% of americans that have experience one type of facial pain ____ was a toothache

Answer 19

12.5%

Question 20

what is peripheral sensitization

Answer 20

increased responsiveness and reduced thresholds of nociceptors to stimulation of their receptive fields

Question 21

what is central sensitization

Answer 21

increased responsiveness of nociceptive neurons in the CNS to their normal or subthreshold afferent input

Question 22

what is heterotopic pain

Answer 22

any pain that is felt in an area other than its true source

Question 23

heterotopic pain cannot be provoked by:

Answer 23

stimulation of the area where the pain is felt

Question 24

heterotopic pain cannot be arrested unless:

Answer 24

the primary source of pain is anesthetized

Question 25

what are the types of non- odontogenic pain

Answer 25

- TMD, muscle pain - neuropathic (neuritis, neuroma, neuralgia) - referred pain (sinusitis, cancer) - neurovascular

Question 26

what is the most common non odontogenic dx

Answer 26

TMD

Question 27

myofascial pain emanates from:

Answer 27

small foci of hyperexcitable muscle tissue

Question 28

myofascial pain areas feel like:

Answer 28

taut bands or knots and are termed trigger points

Question 29

the pain in myofascial pain is described as:

Answer 29

diffuse, constant, dull, aching sensation which may lead the clinician to a misdiagnosis of pulpal pain

Question 30

another potentially misleading characteristic of masticatory muscle pain is that:

Answer 30

patients may report pain when chewing

Question 31

what is the tx for myofascial pain

Answer 31

muscle relaxants every 24 hours at night - cyclobenzaprine/flexeril

Question 32

______ get persistent pain after surgical procedures, and up to ____ are severely affected.

Answer 32

30%; 10%

Question 33

what are the neuropathic red flags

Answer 33

- no apparent etiology - migration of pain, no improvement - does not change with time - atypical (burning, electric shock) - cant be reproduced or provoked - local anesthesia and analgesics ineffective - doesnt respond to dental treatment

Question 34

what is persistent post procedural pain

Answer 34

- consequence of surgery - lasts at least 2 months - no other explanation for pain - not a continuation of preexisting chronic pain condition for which the surgery was performed

Question 35

what can referred pain be from

Answer 35

sinusitis or cancer

Question 36

to dx ODS:

Answer 36

otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings

Question 37

what are the causes of physical damage to the nerve

Answer 37

- post herpetic nerve damage - post surgical nerve damage - post traumatical event nerve damage