ORAL MED - idiopathic orofacial pain

Question 1

describe idiopathic orofacial pain?

Answer 1

unilateral/ bilateral
intraoral/ facial pain
in distribution of trigeminal nerve
persistent, moderate intensity, poorly localised
dull, pressing or burning character

Question 2

list 3 types of idiopathic orofacial pain?

Answer 2

persistent idiopathic facial pain
persistent idiopathic dentoalveolar pain
burning mouth syndrome

Question 3

what are some basic features common to idiopathic orofacial pain?

Answer 3

daily pain
>2 hours duration per day
for >3 months

Question 4

what are some psychological factors that contribute to idiopathic orofacial pain?

Answer 4

stress
anxiety
depression
life events
social isolation
cancerphobia
past traumatic life events

Question 5

what is the role of the GDP in relation to chronic orofacial pain?

Answer 5

good pain history
exclude dental causes
check cranial nerves, urgent referral if any abnormalities
reassure and suggest some self management techniques

Question 6

what are some self management strategies for idiopathic orofacial pain?

Answer 6

relaxation
exercise
distraction
mindfulness

Question 7

what are systemic treatments for orofacial pain?

Answer 7

amitriptyline
SSRIs and SNRIs

Question 8

what service is available in NHS Tayside for pain management?

Answer 8

NHS tayside local pain management service

Question 9

describe persistent idiopathic facial pain?

Answer 9

persistent facial and/ or oral pain
daily >2 hours
> 3 months
absence of clinical neurological deficit

Question 10

diagnostic criteria for persistent idiopathic facial pain?

Answer 10

a. persistent facial and/or oral pain
b. >2 hours/day for >3 months
c. poorly localised and dull/aching
d. neurological exam is normal
e. dental cause exclusion
f. not another diagnosis

Question 11

investigations for persistent idiopathic facial pain?

Answer 11

MRI/CT/CBCT may be considered

Question 12

explain the management in secondary care for persistent idiopathic facial pain?

Answer 12

explanation + reassurance
self management techniques
cognitive behavioural therapy
acceptance and commitment therapy

Question 13

what topical treatments may be prescribed for persistent idiopathic facial pain?

Answer 13

lidocaine ointment
lidocaine patches
capsaicin cream
levomenthol cream

Question 14

what systemic treatments may be prescribed for persistent idiopathic facial pain?

Answer 14

amitriptyline
duloxetine

Question 15

describe persistent idiopathic dentoalveolar pain?

Answer 15

persistent unilateral
IO dentoalveolar pain
>2 hours/ day >3 months
absence of causative event

Question 16

describe burning mouth syndrome?

Answer 16

IO burning/ dysaesthetic sensation
> 2 hours/ day >3 months
no causative lesions

Question 17

what is a cause of burning mouth syndrome?

Answer 17

menopause

Question 18

what sites may burning mouth syndrome affect?

Answer 18

tongue
palate
lips

Question 19

what local causes must be excluded to diagnose burning mouth syndrome?

Answer 19

parafunctional habits
dry mouth
GORD
candidosis

Question 20

what systemic causes must be excluded to diagnose burning mouth syndrome?

Answer 20

anaemia
haematinic deficiency
diabetes (undiagnosed/ poorly controlled)
thyroid dysfunction
medications - ACE inhibitors

Question 21

what is the role of the GDP in regards to persistent idiopathic dentoelveolar pain?

Answer 21

exclude mucosal abnormality, local causes and systemic, in collaboration with GMP
check cranial nerves
reassure, suggest self management, trial of benzydamine mouthwash/ spray
refer

Question 22

what investigations can be carried out to exclude systemic causes of burning mouth syndrome?

Answer 22

FBC
Haematinics (vitB/follate/ferritin)
Glycosylated haemoglobin
Thyroid stimulating hormone
Serum Zinc
Sialometry
Candida swap/ rinse

Question 23

what topical treatments can be prescribed in primary care for managing burning mouth syndrome?

Answer 23

benzydamine mouthwash/ spray (difflam)

Question 24

what topical treatments can be prescribed in secondary care for managing burning mouth syndrome?

Answer 24

capsaicin mouthwash (tabasco sauce in water)
clonazepam - oral rinse/ tablet sucked and then spat out

Question 25

what are systemic treatments prescribed for burning mouth syndrome?

Answer 25

amitriptyline
duloxetine