Odontogenic and Non-odontogenic pain Flashcards
Site of the pain
Where people sense their pain
Source of the pain
The location of a pathophysiologic
process giving rise to the pain (may
or may not be in the same region)
Referred pain
The attribution of pain to an
anatomic region that is different
from the location of the etiologic
process
Pain
An unpleasant sensory and emotional
experience associated with, or resembling that
associated with, actual or potential tissue
damage
Nociceptive
Pain
Pain arising from activation of nociceptors
Neuropathic
Pain
Pain arising as a direct consequence of a
lesion or disease affecting the
somatosensory system.
as emergency treatments for teeth having signs of irreversible pulpitis, pulpotomy, partial pulpectomy and total pulpectomy were comparable with respect to relieving clinical symptoms. — may be preferred because it requires significantly less time and is a simple technique that relieves symptoms quickly and effectively
pulpotomy
can pain be achieved by a single drug method ?
not without significiant side effects
effect of NSAIDs (?)
1.Vasoconstriction
2.Inhibition of
depolarization
3. Analgesic effect
COLD-INDUCED
NEURAPRAXIA
ANTI EDEMA
EFFECT
10ºC
4 MINUTES
Diagnostic yield of conventional radiographic and cone-beam computed
tomographic images in patients with atypical odontalgia
PERSISTENT INTRAORAL PAIN
— increased the amount of detected osseous destructive lesions
CBCT
A nonodontogenic
toothache has a
source of pain that
is
not the tooth the
patient has
indicated
—% OF PAIN “resolved with endo”
90
–% persistent pain
- –% untreated canals, fractures, persistent infection
- –% neuropátic, neurovascular… etc.
10
5
5
Non-dental Pain?
* —% (44 / 78) of cases with persistent pain had a nondental cause Meta analysis, 10 articles 1125 teeth, 78 with persistent pain
- —% (39 / 63) cases with persistent pain
had a non-dental cause
56
62
6-month period
–% of Americans
experienced at least one
of five types of facial pain
–% was
toothache
22
12.2
Peripheral Sensitization
Increased responsiveness and reduced thresholds
of nociceptors to stimulation of their receptive
fields
Central Sensitization
Increased responsiveness of nociceptive neurons in
the central nervous system to their normal or
subthreshold afferent input
Heterotopic Pain
(3)
Any pain that is felt in an area other than its true source is
heterotopic pain.
Cannot be provoked by stimulation of the area where the pain is felt.
Cannot be arrested unless the primary source of pain is anesthetized
types of pain (4)
TMD, muscle pain
Neuropathic (Neuritis,
Neuroma, Neuralgia)
Referred pain (sinusitis,
cancer)
Neurovascular
PTS REPORTING TOOTH PAIN 6 mo after RCT had a nonodontogenic pain dx accounting for some of this pain, with — being the most frequent nonodontogenic dx
TMD
Myofascial pain (MFP) emanates from
small foci of hyperexcitable
muscle tissue
Clinically these areas feel like
taut bands or knots and are termed
trigger points.
The pain is described as
a diffuse, constant, dull, aching sensation;
this may lead the clinician to a misdiagnosis of pulpal pain.
Another potentially misleading characteristic of masticatory muscle
pain is that patients may report pain when
chewing
Muscle relaxants
(ciclobenzaprine/flexeril) every 24 hrs. night!
— is a rare type of chronic intractable endodontic pain and that careful dx of – is important
NTP
—% get persistent pain,
* Up to —% are severely affected
30
10
NEUROPATHIC RED FLAGS
- No apparent —
- — of pain, no improvement
- Does not change with —
- Atypical (2)
- Can’t be (2)
- (2) ineffective
- Doesn’t respond to —
etiology
Migration
time
(Burning, electric shock)
reproduced or provoked
Local anesthesia and analgesics
dental treatment
What is persistent post-procedural
pain (PPSP)?
(4)
*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
dental tx for patients with neuropathic orofacial pain
Don’t touch them!
skipped
Odontogenic sinusitis
3 questions
Should we be diagnosing it?
How often are mucositis and
periodical periostitis
symptomatic?
How fast can these entities
heal?
ODS generally requires — to confirm sinusitis and dental providers to confirm —
otolaryngologists
maxillary odontogenic pathology
Paroxysmal Hemicrania
— Female: Male
Onset — years old
Severe unilateral orbital, supraorbital, and or
temporal pain lasting —
2:1
20-30
10 to 30 minutes
HA is accompanied by at least one of the following
(5)
1.Ipsilateral conjuctival injection and/or lacrimation
2.Ipsilateral nasal congestion and/or rhinorrhoea
3.Ipsilateral eyelid edema
4.Ipsilateral horehead and facial swelling
5.Ipsilateral miosis and/or ptosis
CLUSTER
— Male: Female
Onset — years old
Severe unilateral orbital, supraorbital, and or
temporal pain lasting
3:1
20-29
15 to 180 minutes if untreated
1.Ipsilateral conjuctival injection and/or lacrimation
2.Ipsilateral nasal congestion and/or rhinorrhoea
3.Ipsilateral eyelid edema
4.Ipsilateral horehead and facial swelling
5.Ipsilateral miosis and/or ptosis
6.Sense of restlessness or agitation
Cluster-Unilateral pain
patients dont want to sleep
+ nasal liquid discharge
+ tears
