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Oral medicine > Oral pain > Flashcards

Oral pain Flashcards

1
Q

Different types/causes of facial pain

A 
Dental pain e.g. PAP, pulpitis, cracked tooth, hypersensitivity, post-op
TMD
Osteitis/myelosteitis 
Infections
Burning mouth
Myalgia
Vascular e.g. temporal arteritis
Neurological e.g. cluster headache, trigeminal neuralgia
Trauma
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2
Q

Facial pain - pain history from patient

A 
SOCRATES
TMD
FH, SH, MH
Parafunction
Recent changes to medication, lifestyle, dental work, etc.
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3
Q

Different types of dental pain

A 
PAP - pain on pressure
Pulpitis - pain with stimuli
Cracked tooth - pain when biting stopped
Bruxism - pain on multiple teeth, after waking up
TMD - opening and closing, locking, clicking
Hypersensitivity - cold, sweet
Post-op - cold, sweet
Inflammation - swelling, tender
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4
Q

Initial/general management of a patient in pain ???????

A
  1. Reassure
  2. Explain the diagnosis, treatment options
  3. Biopsychosocial assessment
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5
Q

Referred dental pain

A

Pain in an area triggered by something somewhere else

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6
Q

Burning mouth syndrome

A 
Oral dysthaesia
Burning pain in parts of or all of the mouth
Unknown aetiology but can be triggered by local or systemic factors:
Local
- xerostomia
- bacteria/viral/fungal
- parafunction
- geographic tongue
- reflux
- allergies

Systemic

  • Psychological
  • Vit B12/folate/iron deficiency
  • Hormones/menopause
  • diabetes

Management = treat the underlying cause, manage symptoms. Use antidepressants, CBT, oestrogen

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7
Q

Chronic pain

A

> 3 months

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8
Q

Atypical facial pain - symptoms/diagnosis

A

Daily
Constant
In face - can be in one area or move to different areas
Investigations are all negative - no cause
Associated features = swelling, flushing, altered sensation, lacrimation

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9
Q

Atypical odontalgia symptoms/diagnosis [5]

A
  • Throbbing pain in the tooth or socket but all negative tests and no known cause
  • Treatment of that tooth will not resolve the pain - it will continue or move to another tooth/area
  • Sensitised nerves after RCT/XLA/infection or treatment
  • Tends to be older patients + psychosocial causes
  • Referral to pain services if it doesn’t improve in a week
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10
Q

Hyperalgesia

A

Excessive pain in response to a stimulus

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11
Q

Allodynia

A

Pain response to a non-pain stimulus

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12
Q

Spontaneous pain

A

Pain in the absence of a stimulus

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13
Q

Central sensitisation

A

Nerves/muscles are sensitised so excessive response and more sensitive to stimuli

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14
Q

Abnormal/worrying signs when doing a pain exam

A

Vomiting, headache, photophobia = raised ICP

Abnormal nerve responses

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15
Q

Trigeminal neuralgia presentations

A 
Short
Sharp
Severe
Stabbing
Sudden
Unilateral

Occurs in 1+ trigeminal nerve distributions

In older patients, gets worse with age and worse with movement and during the daytime

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16
Q

Trigeminal neuralgia aetiology

A

Trigeminal ganglion connected to pons through nerves. Demyelination of these nerves can cause electrical signals to jump between the nerves and be very painful

1) classic = vascular hypothesis - artery pressing on nerve causing demyelination
2) secondary to pathology e.g. tumour pressing on nerve, multiple sclerosis causing plaque-like demyelination, peripheral neuropathy
3) idiopathic

17
Q

Management of trigeminal neuralgia

A

Medication

1) Sodium channel blockers e.g. carbamazepine (anti-epileptic, but SE = lupus-like reactions, rash, interacts w warfarin and other drugs)
2) Gabapentin, pregabilin, phenytoin, valproate pain meds

Surgery

  • microvascular decompression (for vascular theory)
  • cryotherapy (superficial nerves)
  • ganglion procedure
  • gamma knife/stereotactic radiosurgery
18
Q

Microvascular decompression for trigeminal neuralgia

A

For vascular theory/classical

  • Surgically reposition the artery so that it is no longer compressing the nerve
  • One-time fix, great results
  • But invasive so the patient needs to be young and fit
  • Severe complications of surgery = meningitis, stroke, cranial nerve deficits, CSF leak.
19
Q

Cryotherapy for trigeminal neuralgia

A

Non-invasive, simple to do.
Can cause scarring, fibrosis and sensory deficit
But can only freeze superficial/peripheral nerves
Temporary bc nerve will grow back (6 months)

20
Q

Stereo-tactic radiosurgery for trigeminal neuralgia

A

Precision high dose radiation to a small area of the brain.
Day case procedure, using a frame to secure the head and MRI scan to locate the nerve.

Damage to the nerve causing fibrosis
One-time
But sometimes doesn’t work, can cause irritation, tingling, numbness

21
Q

Ganglion procedure for trigeminal neuralgia

A

Less invasive but still surgery and GA
Damage the nerve fibres by injecting into the ganglion.
Use a solution, or thermally so that they can’t fire anymore
But only lasts 2-3 years

Can damage surrounding nerves too = other sensory deficits

22
Q

Types of headaches

A

Cluster headaches
Migraines
Temporal arteritis

23
Q

Temporal arteritis symptoms/signs

A

Unilateral or bilateral - new persistant headache
Lack of blood = necrosis.
Pain and tenderness in the temporal region on palpation
Pain and tenderness in MoM and on opening/closing
Reduced pulse in the temporal artery
If it spreads to the ocular artery it can cause blindness

24
Q

Temporal arteritis aetiology

A

Autoimmune disorder.
Antibodies against the elastic layer of the artery, cause inflammation, fibrosis and thickening of temporal artery walls
This reduces or cuts off blood supply to the muscles and soft tissues

25
Q

Temporal arteritis special investigations

A

Palpate
Doppler scan of the artery to see thickening
Blood tests - raised ESR and CRP
Biopsy of temporal artery = inflammation and thickening of the wall

26
Q

Temporal arteritis management

A

Autoimmune = steroids (prednisolone). Higher dose if eye involved.
Urgent referral to ophthalmologist, rheumatologist, GMP

27
Q

Cluster headaches aetiology

A

Unknown cause
Can be triggered by things -
Autonomic condition

28
Q

Cluster headaches symptoms/signs

A

In ocular/temporal/frontal region
Unilateral but can switch between sides
Recurrent episodes, daily attacks for months
Alarm clock headache - severe throbbing burning pain, that wakes the patient up
Horner’s eye signs
+ Rhinorrheo, lacrimation, rash, swelling, red-eye

29
Q

Management of cluster headaches

A

Acute attack = 100% oxygen, 10-12L/min or inject/nasal of triptan
Prevention = avoid triggers e.g. alcohol, coffee and medications like prednisolone, gabapentin, lithium, verapamil

30
Q

Migraine signs/symptoms

A

Headache
Lasts 4-72h
Nausea, photophobia, phonophobia, throbbing
Episodic

31
Q

Migraine triggers

A 
Food
Smells
Stress
Relaxation
Hormones
Oestrogen
32
Q

Migraine management

A 
Symptoms = analgesics, anti-emetics, triptan
Prevention = amitriptyline, beta-blockers
Educate = triggers, physcological methods

Oral medicine (4 decks)

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