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Non-odontogenic pain Flashcards

1
Q

What is Tinel’s signal?

A

Tapping over the area of a neuroma elicits sharp volleys of pain

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2
Q

What is it called when tapping over the area of a neuroma elicits sharp volleys of pain?

A

Tinel’s signal

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3
Q

Who showed that the vast majority of dental nerves are C-fibers that innervate the central pulp and mostly terminate beneath the odontoblasts?

A

Brown, Beeler, Kloka 1985 In article spatial summation of pre-pain and pain in human teeth

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4
Q

Who showed the prevalence of facial pain over a six month period to be 22%?

A

Lipton 1993

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5
Q

Who showed that the most common type of facial pain is toothache (12.2%)?

A

Lipton 1993

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6
Q

What did Lipton find in 1993 about the prevalence of facial pain?

A

over a six month period, one in five Americans experienced it, and the most common cause was a toothache (12.2%).

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7
Q

What are the four major components of nociceptive processing, in the medullary dorsal horn?

A
  1. Central terminals of afferents 2. local circuit neurons 3. projection neurons 4. descending neurons
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8
Q

Where do the central terminals of afferents, local circuit neurons, projection neurons and descending neurons all occur?

A

Medullary dorsal horn (also called the subnucleus caudalis)

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9
Q

Another name for the medullary dorsal horn?

A

Subnucleus caudalis

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10
Q

What is allodynia?

A

Reduction in pain threshold so non-noxious stimuli are painful (sensitivity to chewing)

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11
Q

Sensitivity to chewing during a toothache is an example of?

A

Allodynia (reduction in pain threshold so non-noxious stimuli are painful)

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12
Q

What is the reduction in pain threshold so non-noxious stimuli are painful?

A

allodynia

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13
Q

what is hyperalgesia?

A

Response to noxious stimuli produces more pain than it normally would.

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14
Q

Hypersensitive reaction to cold stimulus during irreversible pulpitis?

A

hyperalgesia

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15
Q

What is the response to noxious stimuli that produces more pain than normal?

A

Hyperalgesia

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16
Q

Who found that stimuli that cause dentinal fluid movement result in a sharp pain associated with A delta fibers?

A

Nahri

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17
Q

Who showed that A delta fibers traverse the odontoblastic layer and terminate in dentinal tubules?

A

Byers 1984

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18
Q

Where do A delta fibers terminate?

A

In dentinal tubules (they traverse the odontoblastic layer) (Byers 1984)

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19
Q

Who showed that c-fibers are more centrally located in the pulp, sensitized by inflammation (most are polymodal)?

A

Dubner

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20
Q

What is the primary site of termination for nociceptive fibers?

A

The subnucleus caudalis (the most caudal area of the trigeminal nerve nuclei)

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21
Q

Who showed that A beta fibers have been shown to undergo phenotypic changes that allow them to encode painful stimuli under inflammatory conditions?

A

Neumann, Doubell and Leslie 1996

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22
Q

What did Neumann Doubell and Leslie find out happens during inflammation in 1996?

A

A beta fibers can undergo phenotypic changes that allow them to encode painful stimuli.

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23
Q

Who showed that local circuit neurons are made of two kind of cells: islet (inhibitory) and stalked (excitatory)?

A

Dubner

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24
Q

Dubner: What are the two kinds of cells in local circuit neurons?

A

islet cells (inhibitory) and stalked cells (excitatory)

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25
Who showed that there are two types of projection neurons (wide dynamic range--signals severity, and nociceptive specific--signals location)?
LeBars, D 2001
26
LeBars 2001: Two types of projection neurons?
Wide dynamic range--signals severity Nociceptive specific--signals location (also, there's a third type:? low threshold mechano-receptors)
27
Who showed that when projection neurons receive stimuli from deep and superficial structures, superficial usually dominates?
Schaible 1988
28
Schaible 1988: When projection neurons receive stimuli from deep and superficial structures, which one usually dominates?
superficial.
29
Who said trigger points are small foci of hyper-excitable muscle tissue?
Travell, J
30
What are trigger points?
Small foci of hyper-excitable muscle tissue.
31
What trigger point refers to the maxillary posterior teeth?
The superior belly of the masseter. (Travell)
32
What trigger point refers to mandibular posterior teeth?
The inferior border of the masseter. (Travell)
33
Who showed that 74% of neurons in a cat brain's subnucleus caudalis showed convergence from tooth pulps?
Sessle and Broton 1998
34
Sessle and Broton 1998
74% of neurons in a cat brain's subnucleus caudalis showed convergence from tooth pulps.
35
What is convergence?
Referred pain that is caused by afferent input from cutaneous and visceral areas onto the same projection.
36
What did Brannstrom theorize (79) and Nahri show (90)?
A delta fibers respond to dentinal fluid movement.
37
Who theorized and who showed that A delta fibers respond to dentinal fluid movement?
Brannstrom (79) and Nahri (90)
38
Descending neurons (to the subnucleus caudalis) originate in what three places?
The nucleus raphe magnus (NRM) The medullary reticular nuclei The locus cerelleus (LC)
39
C and A delta fibers terminate in the __ and __ respectively.
Outer laminae (I and IIa) and lamina V
40
Two things that descending neurons release?
Serotonin from NRM | Norepinephrine from LC
41
What is released from the descending neuron NRM?
serotonin
42
What is released from the descending neuron LC?
norepinephrine
43
pathway of projection neurons?
The axons cross to the contralateral medulla to ascend in the trigeminothalmic tract and to the ventral posterial medial and intralaminar nuclei of the THALAMUS. Then the nerves go to the cortex.
44
What are the only drugs that helps trigeminal neuralgia?
carbamazepine (Tegretol), oxcarbazepine (Trileptal)
45
What did Backonja find about carbamazepine (Tegretol)?
It is the only drug that helps trigeminal neuralgia. Now there is also trileptal (oxcarbazepine)
46
what is diagnostic for a cluster headache?
It's eliminated after ten minutes of oxygen inhalation
47
What is eliminated after ten minutes of oxygen inhalation
a cluster headache
48
Where in the tooth complex are mechanoreceptors most densely concentrated? According to?
Apical third (according to Long)
49
What did Long find out about mechanoreceptors in the tooth complex?
They are located most densely in the apical third (of the periodontal ligament??)
50
Two drugs that migraines are frequently treated with?
Triptans (sumatriptan--Imitrex, rizatriptan--maxalt)
51
What are triptans (sumatriptan, rizatriptan) frequently used to treat?
migraines
52
What did Druce and Slavin find (1991)?
That sinus pain is usually not really painful unless the nasal mucosa is involved.
53
Who found that sinus pain is not usually really painful unless the nasal mucosa is involved.
Druce and Slavin 1991
54
who described central sensitization and what is it?
Bonica; when there is prolonged nociceptive input, and second order neurons become sensitized.
55
What is it called when there is prolonged nociceptive input, and second order neurons become sensitized?
Central sensitization.
56
What is heterotopic pain?
Pain felt in an area outside its true source.
57
What are the three types of heterotopic pain? and who described them?
Referred (occurs in a laminated fashion), central, and projected. Okeson
58
What is pain that is felt in an area outside of its true source?
heterotopic pain
59
What did Okeson describe?
The three types of heterotopic pain.
60
What are the five types of non-odontogenic pain?
1. musculoskeletal 2. neurovascular (headaches) 3. neuropathic (neuralgia) 4. psychogenic (pschologic) 5. pain associated with pathology
61
Two types of hyperalgesia?
1. Primary: sensitization of nociceptors (lowers threshold). 2. Secondary: CNS mechanisms
62
What are three spots to palpate while patient opens to feel for clicking
pretragus, inside ear, behind ear
63
what does pretragus mean
infront of ear
64
are migraines unilateral or bilateral?
unilateral 90% of the time
65
what two specialists should be diagnosing fibromyalgia?
``` a rheumatologist (autoimmune diseases) a physiatrist (physical medicine rehab--PMR) ```
66
What is indomethacin (indocin)? What non-odontogenic pain responds very well to it?
a type of NSAID. PH--paroxysmal hemicrania
67
what is meloxicam (mobic)? often used to treat?
an NSAID. Osteoarthritis
68
Risk caused by long term use of NSAIDs for older patients
predisposes older individuals to stroke and myocardial infarction
69
when patient presents with pain symptoms seemingly with no cause, two things to ask:
``` Recent trauma (such as whiplash or long dental appt.), Pain elsewhere in the body ```
70
Check for numbness where in the head? using what?
V1, V2, V3 mirror for cold mirror for pressure gauze for light touch
71
degeneration of the condyle in a pano is a classic symptom of?
osteoarthritis
72
Two presenting signs of MS in the head/neck?
numbness and trigeminal neuralgia
73
What nerve does bells palsy effect? What happens?
Cranial nerve 7 (the facial nerve). mostly motor symptoms --paralysis or weakness of muscles (not neuro)
74
what is multiple myeloma?
a cancer of your plasma cells, a type of white blood cell present in your bone marrow
75
Four types of leukemia
Acute myeloid leukemia Chronic myeloid leukemia Acute lymphoblastic leukemia Chronic lymphocytic leukemia
76
which leukemia affects primarily children?
acute lymphoblastic leukemia
77
Two types of white blood cells (leukocytes)
granulocytes (have granuoles) | agranulocytes
78
Three types of granulocytes:
neutrophils, basophils, eosinophils
79
which endocrine disease causes punched out lesions and numbness on the face?
parathyroid tumors
80
What does the parathyroid do? | What do it's tumors cause?
regulates calcium levels | numbness on face and punched out bone lesions
81
What is a PET scan?
Positron Emission Tomography: uses radioactive tracer to look for pathology--often cancer-since cells are dividing more rapidly
82
How long does a true migraine last?
4 to 72 hours
83
10 differential diagnoses for TMD
Odontogenic pain, otitis, sinusitis, traumatic injury to head and neck, cervical spine pathologies, migraines and tension headaches, trigeminal neuralgia, Trigeminal Autonomic Cephalagies, Atypical Facial Pain, Facial pain secondary to eoplastic processes
84
Definition of neuralgias? Three types?
Short duration, rapid onset pain conditions. Trigeminal neuralgia Glossopharyngeal neuralgia (rare) Post-herpetic neuralgia
85
What is tegretol? Used to tx?
carbamazepine | trigeminal neuralgia
86
What is trileptal? Used to tx?
Oxcarbazepine | trigeminal neuralgia
87
Is trigeminal neuralgia bilateral or unilateral?
Usually unilateral (right side more likely)
88
Where is glossopharyngial neuralgia felt?
Severe stabbing pain in ear, base of tongue, tonsillar fossa, below angle of mandible.
89
What is eagle's syndrome?
Elongated styloid process that produces pain by impinging on adjacent anatomical structures
90
Four types of pain of vascular origin?
Migraines Tension Headaches Temporal Arteritis Trigeminal Autonomic Cephalgias
91
Migraines have at least two of what four characteristics?
Unilateral Pulsating Moderate or severe pain aggravation by routine physical activity
92
Four common side effects of migraines
nausea, vomiting, photophobia, phonophobia
93
Most commonly used drugs for migraines
Triptans (sumatriptan-imitrex), rizatriptan (maxalt)
94
Ca channel blockers, beta blockers, antidepressants, serotonin antagonists and anticonvulsants can all be used as prophylactic tx for
migraines
95
Who is most likely to get migraines?
Young women
96
Which headache feels like a band wrapped around your head?
Tension-type headaches
97
Tension-type headaches have at least two of what four symptoms
bilateral pressing/tightening (non-pulsating) mild/moderate intensity not aggravated by routine physical activity such as walking or climbing stairs
98
What is NICO? Another name for it?
Neuralgia-inducing Cavitational Osteonecrosis. Ranter's bone cavity
99
Name to remember for describing patterns of referred pain in the mouth?
Glick (1962)
100
Who did two case reports describing barodontalgia?
Senia 1985
101
What did Senia 1985 describe?
barodontalgia
102
Who said the most common referred pain sources to the teeth are the masseter and the lateral pterygoid muscles?
Wright 2000
103
Wright 2000 referred pain
Most common referred pain sources to the teeth are the masseter and the lateral pterygoid muscles

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