Oral Medicine Tutorials Flashcards
What is the epidemiology of Trigeminal Neuralgia?
- affects 4-28 per 100,000 a year
- more common in >50 y/o
- more common in women
What is the pathophysiology of Trigeminal Neuralgia?
- compression or irritation of the trigeminal nerve (usually via BVs)
- rarely can be associated with MS or tumours affecting the nerve
What are the clinical features of Trigeminal Neuralgia?
- sudden, severe, excruciating facial pain
- often triggered by mild stimulation of face
- typically unilateral
- pain usually brief, but can. occur in clusters
What is the diagnosis criteria for trigeminal neuralgia?
- recurrent bursts of unilateral facial pain in distribution of trigeminal nerve
- the pain = lasts for fraction of second to 2 mins, severe intensity, electric shock like/shooting/stabbing
- precipitated by innocuous stimuli within trigeminal distribution
- not better accounted for by another pain diagnosis
What other craniofacial neuropathies might be considered in the differential diagnosis of trigeminal neuralgia?
- atypical facial pain
- postherpetic neuralgia
- cluster headaches
- maxillary sinusitis
- dental / odontogenic pain
How might you differentiate between trigeminal neuralgia pain vs odontogenic pain?
Odontogenic pain = tends to be localised, constant & associated with dental pathology
TN = no evidence of dental pathology, sporadic pain or pain from stimulation
What is the first line drug used to treat trigeminal neuralgia?
Carbamazepine (600-1200mg/day)
What drugs may be used to treat trigeminal neuralgia?
- carbamazepine
- pregabalin
- gabapentin
- valproate
Other than medication, what treatment is available for Trigeminal Neuralgia?
- microvascular decompression surgery
- gamma knife radiation directed at trigeminal nerve
- cryotherapy
- TENS therapy
- acupuncture
- relaxation techniques
- dietary modifications
Who is Burning Mouth Syndrome more likely to occur in?
- middle aged/older adults
- more common in women after menopause
What are risk factors for development of burning mouth syndrome?
- anxiety or depression
- hormonal chages
- nutritional deficiencies
- oral habits
- medical conditions
What is the aetiopathogenesis of burning mouth syndrome?
Many theories!
- alterations in nerve function
- psychological factors
- dysfunction or damage to nerves that supple oral mucosa
- postmenopausal hormonal changes
- stress/anxiety/depression
- oral candidiasis
What are the symptoms of burning mouth syndrome?
- persistant burning or tingling sensation in the mouth
- no visible signs of irritation
- discomfort varies in intensity throughout the day
Give examples of potential triggers for development of burning mouth syndrome:
- acidic/spicy foods or drinks
- oral habits such as toothbrushing
What investigations would you carry out in a patient with suspected burning mouth syndrome?
- oral examination to rule out infection/lesions etc
- blood tests to check haematinics & diabetes/thyroid
- salivary flow tests
- biopsy in some cases
