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DG2016 - CK 2 > Non-Dental Facial Pain > Flashcards

Non-Dental Facial Pain Flashcards

1
Q

What are the 6 classifications of orofacial pain?

A
  • intra oral
  • extra oral
  • musculoskeletal
  • neuropathic
  • neurovascular
  • psychological
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2
Q

What is an example of episodic neuropathic pain?

A

trigeminal neuralgia

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3
Q

What are 3 examples of continuous neuropathic pain?

A
  • trigeminal neuropathy
  • atypical odontalgia
  • post-herpetic neuralgia
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4
Q

Which neurovascular pain condition would need an emergency referral?

A

temporal arteritis

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5
Q

What are 4 examples of facial pain red flags?

A
  • bilateral facial pain described as toothache
  • toothache with absence of dental pathology
  • pain radiating to forehead, temple, cervical regions
  • toothache with hearing changes, vertigo, tinnitus, facial weakness, altered facial sensation
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6
Q

What are the 7 main components of history taking when assessing non dental facial pain?

A
  • principle complaint
  • presenting illness
  • past medical history
  • past dental history
  • habits: smoking, alcohol, drugs
  • psychosocial history: stress, depression, anxiety
  • consider all symptoms
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7
Q

What are the 4 most common causes of facial pain?

A
  • oral ulceration
  • sinus pain (maxillary, frontal, ethmoid)
  • TMJ
  • idiopathic trigeminal neuralgia
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8
Q

How is the TMJ examined?

A
  • assess joint click/crepitus
  • examine muscles of mastication esp. temporalis, masseter, pterygoids difficult to palpate
  • range of opening and lateral movement
  • deviation/deflection on opening
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9
Q

What conservative treatment options are there for a patient with TMJ?

A
  • rest and soft diet
  • NSAIDs
  • physio and exercises
  • heat pack if joint/muscle is uninjured
  • reduce stress
  • acupuncture
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10
Q

What are examples of splints that can be given to patients with TMJ and conservative treatment has not worked?

A
  • emergency splint (de-programming Lucia jig)
  • soft splint
  • hard acrylic splint
  • local occlusal interference splint (LOIS)
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11
Q

What medication can be used for TMJ that has not been responsive to other treatments?

A

diazepam

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12
Q

What is the surgery used to help with TMJ if other treatment has not worked?

A

arthroscopy (is the disc damaged and needing surgery? manipulation under GA)

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13
Q

The symptoms of which condition is the following?
- pain over upper cheek and teeth, may be bilateral
- worse when being forward
- history of upper respiratory tract infection (cold)

A

sinusitis

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14
Q

Signs of which condition are the following?
- maxillary teeth TTP
- may be nasal discharge
- tenderness, erythema over maxilla

A

sinusitis

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15
Q

What special investigations can be done to assess potential sinusitis?

A
  • bitewing and/or PA to exclude dental cause
  • radiograph may show fluid level in maxillary antrum, OPG (not justified for diagnosis unless dental involvement in suspected)
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16
Q

What are the treatment options for sinusitis?

A
  • decongestants
  • steam inhalations
  • analgesics
  • antibiotics last resort
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17
Q

What are the 2 types of trigeminal neuralgia?

A
  • classic/idiopathic trigeminal neuralgia
  • symptomatic/secondary trigeminal neuralgia
18
Q

Which type of neuralgia would present with pain - ear, base of tongue, tonsillar regions?

A

glossopharyngeal neuralgia

19
Q

Which type of neuralgia would present with pain - deep in ear canal?

A

nervus intermedius neuralgia

20
Q

Which type of neuralgia would present with pain - distribution of greater and lesser occipital nerve?

A

occipital neuralgia

21
Q

Which type of neuralgia would present with pain - post herpes zoster - often ophthalmic branch?

A

post herpetic neuralgia

22
Q

Which medication is the following?
- drug of choice for trigeminal neuralgia
- anti-epileptic drug
- interactions common eg. Warfarin
- side effects: drowsiness, nausea, folic acid deficiency, megaloblastic anaemia

A

carbamazepine

23
Q

Which type of trigeminal neuralgia is the following?
- predominantly forehead or orbit
- may be bilateral
- facial sensory or motor impairment
- red flag: tumours, aneurysm, MI, MS

A

secondary trigeminal neuralgia

24
Q

What are 4 things that should be done for a patient presenting with trigeminal neuralgia?

A
  • exclude dental causes of pain
  • advisable to consult GP first
  • diagnostic carbamazepine and review
  • arrange prompt referral to specialist
25
Q

What are 5 differences between pulpitic pain and trigeminal neuralgia?

A

pulpitic pain:
dental pathology
throbbing
exacerbated with hot and cold
LA blocks pain
sleep disturbed

trigeminal neuralgia:
no local cause
shooting, lacerating, burning pain
food temperature no effect
LA may not block pain
no effect on sleep

26
Q

What are 4 neurological causes of facial pain?

A
  • trigeminal neuralgia
  • glossopharyngeal neuralgia
  • herpes zoster
  • multiple sclerosis
27
Q

Which cause of facial pain is the following?
- sudden, brief, severe, recurrent pain in the distribution of the glossopharyngeal nerve
- unilateral pain in throat/ear
- sharp, stabbing
- sudden onset, last a few seconds/mins
- may be triggered by coughing or swallowing
- 10% also have trigeminal neuralgia

A

glossopharyngeal nerve

28
Q

Which cause of facial pain is the following?
- common, 20% of adults
- oral symptoms are less common
- painful vesicles that ulcerate, do not cross midline
- severe lancing pain may occur before vesicles - difficult diagnosis
- management: reassurance, paracetamol

A

zoster - shingles

29
Q

Which cause of facial pain is the following?
- persists after shingles outbreak
- increases with age
- severity increases with age
- treatment: anti depressants

A

post-herpetic neuralgia

30
Q

What are 5 psychogenic causes of facial pain?

A
  • TMJ
  • atypical facial pain
  • atypical odontalgia
  • burning mouth syndrome
  • Münchausen syndrome
31
Q

Which type of psychogenic facial pain is the following?
- dull ache
- maxillary > mandibular
- present all day, everyday
- does not follow anatomical nerve distribution
- other complaints: dry mouth, altered taste, thirst, IBS, chronic back pain

A

atypical facial pain

32
Q

Which type of psychogenic facial pain is the following?
- variant of atypical facial pain
- pain well localised to a tooth/teeth
- symptoms may mimic pulpitis or periodontitis
- dental intervention can aggravate the pain
- extraction may lead to transfer of pain to other teeth or alveolus

A

atypical odontalgia

33
Q

Which type of psychogenic facial pain is the following?
- usually middle aged females
- can be generalised or localised burning or soreness of the mouth
- often affects tongue (glossodynia)
- oral mucosa appears normal
- 1-2 cases per year in GDP

A

burning mouth syndrome

34
Q

What are 6 other potential causes of facial pain?

A
  • diabetes
  • xerostomia
  • geographic tongue
  • lichen planus
  • candidosis
  • glossitis associated with vitamin deficiency
35
Q

Which 4 testing methods should be carried out to diagnose cause of facial pain?

A
  • blood, urine, thyroid function
  • microbiology (candida)
  • salivary flow rate
  • psychological screening
36
Q

Which antidepressants are used to treat atypical facial pain?

A
  • tricyclic anti depressants
  • SSRIs
37
Q

What are 4 side effects of tricyclic anti depressants?

A
  • sedation
  • xerostomia
  • constipation
  • blurred vision
38
Q

What are 4 side effects of SSRIs?

A
  • nausea
  • xerostomia
  • dyspepsia
  • vomiting
39
Q

What are 3 vascular causes of facial pain?

A
  • migraine
  • cluster headaches
  • temporal arteritis
40
Q

Which type of vascular cause of facial pain is the following?
- severe, unilateral headache
- lasts for hours-days
- nausea or vomiting
- triggers: stress, diet, light
- aura: visual, sensory, motor or speech disturbance

A

migraine

41
Q

Which type of vascular cause of facial pain is the following?
- male > female, age 30-50
- unilateral, dull pain
- can wake patient at night
- localised around eye
- can be associated with watering eye and nasal discharge

A

cluster headaches

42
Q

Which type of vascular cause of facial pain is the following?
- aged 50 years +
- new onset of localised headache
- unilateral, deep throbbing pain in temple
- worse when lying flat
- malaise, fever, weight loss
- tenderness of temporal arteries
- treatment: urgent referral - corticosteroids as sight at risk

A

temporal arteritis

DG2016 - CK 2 (10 decks)

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