ORAL MED - idiopathic orofacial pain Flashcards
describe idiopathic orofacial pain?
unilateral/ bilateral
intraoral/ facial pain
in distribution of trigeminal nerve
persistent, moderate intensity, poorly localised
dull, pressing or burning character
list 3 types of idiopathic orofacial pain?
persistent idiopathic facial pain
persistent idiopathic dentoalveolar pain
burning mouth syndrome
what are some basic features common to idiopathic orofacial pain?
daily pain
>2 hours duration per day
for >3 months
what are some psychological factors that contribute to idiopathic orofacial pain?
stress
anxiety
depression
life events
social isolation
cancerphobia
past traumatic life events
what is the role of the GDP in relation to chronic orofacial pain?
good pain history
exclude dental causes
check cranial nerves, urgent referral if any abnormalities
reassure and suggest some self management techniques
what are some self management strategies for idiopathic orofacial pain?
relaxation
exercise
distraction
mindfulness
what are systemic treatments for orofacial pain?
amitriptyline
SSRIs and SNRIs
what service is available in NHS Tayside for pain management?
NHS tayside local pain management service
describe persistent idiopathic facial pain?
persistent facial and/ or oral pain
daily >2 hours
> 3 months
absence of clinical neurological deficit
diagnostic criteria for persistent idiopathic facial pain?
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
investigations for persistent idiopathic facial pain?
MRI/CT/CBCT may be considered
explain the management in secondary care for persistent idiopathic facial pain?
explanation + reassurance
self management techniques
cognitive behavioural therapy
acceptance and commitment therapy
what topical treatments may be prescribed for persistent idiopathic facial pain?
lidocaine ointment
lidocaine patches
capsaicin cream
levomenthol cream
what systemic treatments may be prescribed for persistent idiopathic facial pain?
amitriptyline
duloxetine
describe persistent idiopathic dentoalveolar pain?
persistent unilateral
IO dentoalveolar pain
>2 hours/ day >3 months
absence of causative event
describe burning mouth syndrome?
IO burning/ dysaesthetic sensation
> 2 hours/ day >3 months
no causative lesions
what is a cause of burning mouth syndrome?
menopause
what sites may burning mouth syndrome affect?
tongue
palate
lips
what local causes must be excluded to diagnose burning mouth syndrome?
parafunctional habits
dry mouth
GORD
candidosis
what systemic causes must be excluded to diagnose burning mouth syndrome?
anaemia
haematinic deficiency
diabetes (undiagnosed/ poorly controlled)
thyroid dysfunction
medications - ACE inhibitors
what is the role of the GDP in regards to persistent idiopathic dentoelveolar pain?
exclude mucosal abnormality, local causes and systemic, in collaboration with GMP
check cranial nerves
reassure, suggest self management, trial of benzydamine mouthwash/ spray
refer
what investigations can be carried out to exclude systemic causes of burning mouth syndrome?
FBC
Haematinics (vitB/follate/ferritin)
Glycosylated haemoglobin
Thyroid stimulating hormone
Serum Zinc
Sialometry
Candida swap/ rinse
what topical treatments can be prescribed in primary care for managing burning mouth syndrome?
benzydamine mouthwash/ spray (difflam)
what topical treatments can be prescribed in secondary care for managing burning mouth syndrome?
capsaicin mouthwash (tabasco sauce in water)
clonazepam - oral rinse/ tablet sucked and then spat out
what are systemic treatments prescribed for burning mouth syndrome?
amitriptyline
duloxetine
