ORAL MED - orofacial pain

Question 1

what are the 2 main systems of classifying orofacial pain?

Answer 1

international classification of headache disorders
international classification of orofacial pain

Question 2

what category of orofacial pain does trigeminal neuralgia fall under?

Answer 2

pain attributed to lesion or disease of the trigeminal nerve

Question 3

give a description of trigeminal neuralgia?

Answer 3

recurrent unilateral brief electric shock-like pains
abrupt in onset and termination

Question 4

what is the diagnostic criteria for trigeminal neuralgia?

Answer 4

a. recurrent, unilateral facial pain of 1/more divisions of the trigeminal nerve
b. pain lasts from 1 second-2mins, severe intensity, electric shock like
c. precipitated by innocuous stimuli
d. not better accounted for by another diagnosis

Question 5

what are provoking factors of trigeminal neuralgia?

Answer 5

chewing
talking
touching
cold

Question 6

what are the 3 types of trigeminal neuralgia?

Answer 6

classical
secondary
idiopathic

Question 7

describe classical trigeminal neuralgia?

Answer 7

develops without apparent cause other than neurovascular compression

Question 8

how is classical trigeminal neuralgia diagnosed?

Answer 8

MRI/ surgery - morphological changes in the trigeminal root

Question 9

how secondary trigeminal neuralgia caused?

Answer 9

caused by an underlying disease:
- multiple sclerosis
- space occupying lesion
- other

Question 10

investigations for trigeminal neuralgia?

Answer 10

high resolution magnetic resonance imaging

Question 11

what is first line pharmacological treatment for trigeminal neuralgia?

Answer 11

carbamazepine

Question 12

what are the properties of carbamazepine?

Answer 12

anti-convulsant
metabolised in the liver
excreted in urine

Question 13

list some contraindications and cautions for carbamazepine?

Answer 13

pregnancy
hepatic and renal impairment
herbal - st johns wort, alcohol, grapefruit

Question 14

what are some second line treatments for trigeminal neuralgia?

Answer 14

pregablin
gabapentin

Question 15

what additional management can be prescribed by GDPs for trigeminal neuralgia?

Answer 15

lidocaine nasal spray (maxillary pain)
lidocaine ointment (trigger point)
lidocaine as infil/block

Question 16

what are the different surgical managements of trigeminal neuralgia?

Answer 16

palliative destructive at the level of the grasserion ganglion
posterior cranial fossa surgery

Question 17

role of the GDP in regards to trigeminal neuralgia?

Answer 17

diagnosis
exclusion of dentoalveolar pathology
initiate medical management in conjunction with GMP
refer

Question 18

describe glossopharyngeal neuralgia?

Answer 18

unilateral brief stabbing pain
abrupt in onset and termination
pain in the ear, base of tongue, tonsillar area and beneath angle of the mandible

Question 19

what commonly provokes glossopharyngeal neuralgia?

Answer 19

swallowing
talking
coughing

Question 20

diagnostic criteria for glossopharyngeal neuralgia?

Answer 20

a. recurring unilateral pain
b. lasts from 1second - 2 mins, severe intensity, electric shock-like, precipitated by swallowing, coughing, talking/ yawning
c. not diagnosed otherwise

Question 21

what investigations are used for glossopharyngeal neuralgia?

Answer 21

high resolution MRI or head and neck

Question 22

systemic management for glossopharyngeal neuralgia?

Answer 22

carbamazepine

Question 23

list 3 types of painful trigeminal neuropathies?

Answer 23

painful trigeminal neuropathy attributed to HZV
trigeminal post-herpetic neuralgia
painful post-traumatic trigeminal neuropathy

Question 24

what is allodynia?

Answer 24

pain in response to a stimulus which would not normally cause pain

Question 25

what is hyperalgesia?

Answer 25

increased response to a stimulus which would normally cause pain

Question 26

what is hypoalgesia?

Answer 26

reduction in response to a stimulus which would normally cause pain

Question 27

what is hyperaesthesia?

Answer 27

increased cutaneous/ mucosal sensitivity to a stimulus

Question 28

what is dysaesthesia?

Answer 28

an unpleasant sensation affecting the skin/ mucosa

Question 29

describe painful trigeminal neuropathies?

Answer 29

indicative of neural damage primary pain usually continuous mechanical allodynia and cold hyperalgesia common

Question 30

describe painful trigeminal neuropathy attributed to herpes zoster virus?

Answer 30

unilateral facial pain less than 3 months duration in trigeminal region other symptoms of acute herpes zoster

Question 31

describe trigeminal post-herpetic neuralgia?

Answer 31

unilateral facial pain lasting at least 3 months in the trigeminal region caused by herpes zoster

Question 32

how is shingles prevented?

Answer 32

immunisation against herpes zoster for 65-69 yr olds

Question 33

how is trigeminal post-herpetic neuralgia prevented?

Answer 33

antivirals up to 72 hours following appearance of lesions of shingles

Question 34

topical management of trigeminal neuropathy associated with herpes zoster?

Answer 34

lidocaine patches

Question 35

systemic management of trigeminal neuropathy associated with herpes zoster?

Answer 35

amitriptyline

Question 36

describe painful post-traumatic trigeminal neuropathy?

Answer 36

unilateral/ bilateral facial/ oral pain caused by trauma to trigeminal nerve other symptoms of trigeminal nerve dysfunction

Question 37

diagnostic criteria for post traumatic trigeminal neuropathy?

Answer 37

a. history of trauma to trigeminal nerve with signs of nerve dysfunction b. pain localised to trigeminal nerve affected by trauma, developing less than 6 months after event c. no other diagnosis