Oral Med - pain Flashcards
symptoms of trigeminal neuralgia
- repeat attacks of electric shock like pain in face or mouth
- pain lasts from seconds up to 2 mins
- can be spontaneous or brought on by innoculous stimuli (trigger zones)
- unilateral (mostly)
(may have trigger area
explain trigeminal neuralgia to a patient and what causes it
condition affecting trigeminal nerve - one of the large nerves of face and mouth
causes sudden and severe attacks of pain on one side of face
more common in women and over 50s
Cause is often unknown, sometimes due to blood vessel pressing on nerve , rare occasions of tumour pressing on nerve or multiple sclerosis
No cure, but treatments to make manageable
GDP investigations for trigeminal neuralgia
Radiographs to rule out dental cause
Immediate referral to specialist if suspected
GDP treatment of trigeminal neuralgia
Rule out dental cause
prescription of carbamazepine and urgent referral to specialist
Ask GP for FBC and LFT
(10 day carbamazepine regimen)
1st and 2nd line treatment of trigeminal neuralgia
1st line - carbamazepine (side effects include dizzyness and leukopenia)
2nd line - alternate drug e.g lamotrigine
If no success with drugs surgery may be considered
tests to be done prior to carbamazepine prescription
FBC
LFT
U and E
describe burning mouth syndrome to a patient (oral dysaesthesia)
Chronic condition seeing altered and often unpleasant sensations in the mouth with the absent of an obvious cause in the mouth or the body as a whole.
Cause is poorly understood
Usually present daily.
Examination shows clinically normal appearance despite symptoms being very real.
Most common in post menopausal women
symptoms of burning mouth syndrome (oral dysaesthesia)
burning/ unpleasant sensation of tongue (most common) and other areas of mouth
Discomfort usually present daily and may worsen as day progresses
Symptoms may increase with talking, eating spicy or acidic foods, stress
diagnostic tests for BMS
no tests to confirm - relies on patient history
FBC, haematinic screen , autoantibody screen, HbA1c test may be done to rule out other causes of pain
GDP treatment of BMS
Reassurance and acknowledgement
simple advice - suck ice cubes, avoid spicy/ acidic foods
difflam spray
Refer to OM and ask GP for FBC, haematinic screen, HbA1c
differential diagnoses for trigeminal neuralgia
idiopathic facial pain
trigeinal autonomic cephalgias
painful trigeminal neuropathy
inocculous stimuli that may bring on a TN attack
smiling
eating
washing face
wind/ breeze
toothbrushing
OM treatment of oral dysaesthesia (BMS)
medications - clonazepam, TCAs,
CBT referral
