odontogenic and non-odontogenic pain Flashcards
site of pain
where pt senses it
source of 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
what technique to is preffered to remve pain of SIP
pulpotomy, less time and simple
can acute pain be managed with a single Rx/ method
no, required multi-modal/ balanced analgesia approach
NSAIDS increase the risk of?
CVD
triple whammy of Rx interations
effects of cryotherapy as an analgesic
intracanal cryotherapy
can decrease post op pain
apical fenestration and pain
A nonodontogenic toothache
A nonodontogenictoothache has a source of pain that
is not the tooth the patient has indicated
Diagnostic challenge
pain resolution with endo
90%
how many cases have persistant pain, possible explanation
10%
- 5% untreated canals, fractures, persistent infection
- 5% neuropátic, neurovascular… etc
Non-dental Pain as persistant pain?
six month period study of pain
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
Any pain that is felt in an area other than its true source isheterotopic 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.
most frequent non-odonto pain associated with RCT
TMD
Myofascial pain (MFP)
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.
tx MFP
Muscle relaxants (ciclobenzaprine/flexeril) every 24 hrs. night!
Neuropathic (Neuritis,
Neuroma, Neuralgia
can occur post endo tx , rare and chronic
endo tx persistant pain
% severly affect
- 30% get persistent pain
- Up to 10% are severely affected
NEUROPATHIC RED FLAGS
- No apparent?
- Migration of? no?
- Does not change with?
- sense?
- Can’t be?
- Local anesthesia and analgesic?
- Doesn’t respond to?
- No apparent etiology
- Migration of pain, no improvement
- Does not change with time
- Atypical (Burning, electric shock)
- Can’t be reproduced or provoked
- Local anesthesia and analgesics ineffective
- Doesn’t respond to dental treatment
What is persistent post-procedural
pain (PPSP)?
*Consequence of?
*Lasts at least?
*No other explanation for?
*Not a continuation of?
*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
do we tx pts with neuropathic orofacial plane
no
forms of reffered OF pain
sinusitis and cancer
Odontogenic sinusitis
Should we be diagnosing it?
dont diagnose this
dentist role in odontogenic sinusitis
confirm maxillary odontogenic pathology
Paroxysmal Hemicrania
2:1 Female: Male
Onset 20-30 years old
Severe unilateral orbital, supraorbital, and or
temporal pain lasting 10 to 30 minutes
- HA is accompanied by at least one of the following
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
3:1 Male: Female
Onset 20-29 years old
Severe unilateral orbital, supraorbital, and or
temporal pain lasting 15 to 180 minutes if untreated
2.1.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 pts and sleep
patients dont want to sleep
+ nasal liquid discharge
+ tears
