Lo 11 Flashcards
Describe neuropathic orofacial pain
Neuropathic pain can mimic dental and periodontal pain and be confusing to both patient and clinician
What are the two main categories of neuropathic pain?
- Episodic
- Continuous or chronic
Describe burning mouth syndrome
- Characterized by an unexplained and usually continuous burning sensation of the oral soft tissues
- Most likely a neuropathic etiology
- Onset is usually spontaneous and can occur in episodes with periods of latency
- Evaluation involves a careful workup
- Laboratory testing may identify undiagnosed systemic diseases such as anemia and diabetes mellitus
Describe Trigeminal Neuralgia
- Pathologic condition involving the fifth cranial nerve
- Characterized by a unilateral sharp, shooting, knifelike, or electric shock–type pain
- Etiology is unknown can be related to nerve damage
- Sometimes related to local anesthetic injections
- Diagnosis is based on history and onset of pain, and associated clinical symptoms
Describe Bell Palsy
- Acute loss of muscle control on one side of the face
- Related to the 7th cranial (facial) nerve
- Occurs in people of all ages; mostly between ages 15 and 45
- Usually resolves in 6 weeks- 4 months, sometimes permanent
- Dental hygiene contraindicated until resolution due to injury risk
- Cause unknown, trauma related in some cases
Describe Diseases Affecting the Temporomandibular Joint (TMJ)
- Disorders of the TMJ include myofascial pain and dysfunction (MPD), internal derangement syndrome, osteoarthritis, and rheumatoid arthritis
- Benign and malignant tumors can also affect the TMJ
Describe the anatomy of the TMJ
- The TMJ is an articulation between the condyle of the mandible and the glenoid fossa of the temporal bone
- Fibrocartilage covers the bony articulating surfaces
- Ginglymoarthrodial movement
- An articular disk divides the space
- Avascular and devoid of nerve fibers
- Synovial fluid provides nourishment and lubrication
Palpation of the muscles of mastication may be done to determine whether muscle spasm or dysfunctional muscle activity is occurring. Such as:
- Masseter
- Temporalis
- Medial pterygoid
- Lateral pterygoid
- Anterior digastric
- Mylohyoid
Describe normal function of the TMJ
- In the position of maximal occlusal contact, the mandibular condyle rests within the glenoid fossa
- The articular disk is situated between the condyle, the roof of the glenoid fossa, and the articular eminence
- The first phase of opening is characterized by a rotational (hinge) movement of the condyle followed by an anterior translation (sliding)
List the demographic and physiologic factors associated with TMDs
- Majority of patients are female
- Between 20 and 40 years of age
- Female sex hormones play a role
- Depression
- Rheumatoid arthritis
- Chronic fatigue syndrome
- Chronic headache
- Fibromyalgia
- Sleep disturbances
- Irritable bowel syndrome
Describe the Pathophysiology of TMDs
- Trauma - Direct (assault); Indirect (whiplash injury); Resulting from parafunctional habits such as clenching or bruxism
- Psychosocial factors (stress)
- Dentofacial deformities
- May be associated with disorders in growth and development as in condylar hyperplasia or hypoplasia
- Abnormalities are associated with a number of systemic diseases - Depression; Rheumatoid arthritis and osteoarthritis; Chronic fatigue syndrome; Chronic headache; Fibromyalgia; Sleep disturbances; Irritable bowel syndrome
- Female sex hormones play a role
- Iatrogenic cause
Describe patient evaluation for orofacial pain
- Dysfunction may be caused by disorders of muscles of mastication or by internal derangements of components of the joints
- Evaluation involves a comprehensive history and thorough clinical examination - Chief complaint; History: Chief complaint, medical, dental; Examination; Imaging
- Patient management - Reduced mouth opening; Shorter appointments; Pain control
- Three cardinal features of TMDs - must have at least 1 - Orofacial pain; Joint noise; Restricted jaw function
What questions related to patient history should you ask related to orofacial pain
- Medical/dental history
- Precipitating events
- Circumstances that exacerbate or diminish symptoms
- Onset and progression of symptoms - Joint symptoms (clicking, popping); Pain; Problems with mastication; Trismus (lockjaw); Malocclusion; Parafunctional habits (bruxing, clenching); Extensive dental or orthodontic treatment; History of surgical treatment of the jaws
Describe clinical examination of the TMJ
- Includes examination of the joint, muscles of mastication, oral cavity, and cervical spine
- Palpitation upon jaw movement
- Are joint noises such as clicking, crepitus, or popping related to mandibular movement?
- Evaluate movement of mandible in a normal rotation and translatory cycle
- Measure interincisal opening and note any obvious deflection to the right or left side
6 . Note lateral excursions, protrusions, deviations, and deflection - Evaluate occlusion
What are the options for imaging for orofacial pain?
- Panoramic
- Transcranial
- Magnetic resonance imaging
- Computed tomography
- Tomography
- Arthrography