Oral Med Revision - Oral Dysaesthesia

Question 1

what is oral dysaesthesia

Answer 1

an IO burning or dysesthetic sensation in oral mucous membrane & tongue that recur for >2hr/day for >3mths without clinically evident causative lesions

Question 2

aetiology of OD

Answer 2

considered a neuropathic pain
poorly understood aetiopathogenesis
symptoms classically inc pain
may present as - prickling, burning, numb, tingling, shooting sensation

Question 3

what do pts c/o with regards OD

Answer 3

• tip of tongue nips all the time
• feels like sandpaper rubbed on tongue
• feels like CW in mouth
• dry mouth
• tingling sensation on roof of mouth
• feels like mouth on fire
• wake up with dry burning mouth, chemical taste & smell
• mouth feels fluffy

Question 4

SOCRATES oral dysaesthesia

Answer 4

S - anterior 1/3 tongue, palate, lips, labial mucosa, can be multiple
O - random onset, few mths, few yrs, times of stress, recent dental intervention
C - prickling, burning, numb, tingling, shooting sensation
R - no spread
A - dry mouth sensation, altered taste
T - worse at night, less noticeable when busy, constant
E - worry, when unoccupied, eating & drinking = relief
S - won’t wake from sleep, may make getting to sleep more difficult

Question 5

OD red flag features

Answer 5

objective numbness / permanently lost sensation
unilateral symptoms
dysphagia
odynophagia
weight loss
loss of balance / hearing change
unexplained motor or other sensory changes

Question 6

OD exam

Answer 6

EO - normal
IO - normal
exclude: fungal infection, mucosal dx i.e. OLP, odontogenic infection, dry mouth, parafunction, tongue thrusting
cranial nerve exam = normal

Question 7

OD investigations

Answer 7

FBC - anaemia
haematinics - b12, folate, ferritin deficiency
thyroid function tests - hypo/hyperthyroidism accounting for symptoms
HbA1c - exclude diabetes
may consider - oral rinse, sialometry, zinc, patch testing

Question 8

OD mx

Answer 8

take hx that includes q’s on triggers & impact on everyday life
look for other diagnoses
show empathy
recognise pain is real & tell them this
provide BMD leaflet
exclude dental / mucosal cause
explain no worrying features but acknowledge symptoms
refer to OM
GP for bloods
consider saliva substitutes & difflam

Question 9

OD mx in 2ndary care

Answer 9

psychological therapy - counselling / CBT
improving sleep - reduce caffeine, alcohol, sleep, dw GP
holistic - exercise, explanation of chronic pain
topical - saliva substitutes, difflam, clonazepam MW
systemic - tricyclic ADs, duloxetine, anticonvulsants i.e. gabapentin, pregabalin, alphalipoic acid