Oral Pain and its mangament (no lecture)

Question 1

What are the structures in the oral cavity and the maxillofacial region?

Answer 1

teeth, gingiva, mucosa, salivary glands, muscles, bones, ligaments, tendons, blood and lymphatic vessels, taste buds, nerves

Question 2

What is the most prevalent pain in the facial region?

Answer 2

toothache
-odonalgia

Question 3

what percentage of people report tooth ache in the past 6 months?

Answer 3

12-14%

Question 4

Are all toothahces the same?

Answer 4

nah fam

Question 5

What are odotogenic?

Answer 5

pulpal and periodontal

Question 6

What are non-odontogenic?

Answer 6

sinus/nasal, myofascial, neurovascular, neuropathic, cardiogenic, systemic, idiopathic

Question 7

What are other sources of orofacial pain?

Answer 7

mucosal pain, TMDs, orofacial neuropathic pain, neurovascular pain, sleep disorders

Question 8

What does TMD involve?

Answer 8

joint sounds

Question 9

What is pain?

Answer 9

unpleasant sensory and emotional experience assiociated with actual or potential tissue damage or described in terms of such damage

Question 10

Why do we feel pain?

Answer 10

instills protectivebehavior but if unabated, pain can be harmfuil

Question 11

What are the principles of pain?

Answer 11

-always subjective
-may or may not be tied to a stimulus
-always a consequence of an emotioanl experience and psychological state

Question 12

How do we experience pain usually?

Answer 12

-environmentla stimulus
-receptor activaiton
-generation of action potential
-transmission through primary afferent to dorsal horn
-projection from dorsal horn to brain for perception and interpretation

Question 13

What are the biological factors of pain experience?

Answer 13

-genetics
-physiology
-neurochemistry
-tissue heath

Question 14

What are the psychological factors of pain experience?

Answer 14

perceived control, self-efficacy, catastrophic thinking, hypervigilance, depression, anxiety, anger

Question 15

What are the social factors of pain experience?

Answer 15

socioeconomic status, social, skepticism, operant, social support, social learning

Question 16

What is the descending spinal pathway

Answer 16

-endogenous opoid signaling
-non-opioid inhibitatory neurotransmitters

Question 17

What is the descending supraspinal pathway?

Answer 17

-influenced by psychological
-neurons from the cortex and amygdala
-periaqueductal gray and rostroventral

Question 18

What is involved with supraspinal modulation?

Answer 18

psychological, emotional, and placebo

Question 19

What is involved with spinal modulation?

Answer 19

neurotransmitters, neuropeptides, interneurons, endogenous opioids, central sensitization

Question 20

What is involved with peripheral modulation?

Answer 20

peripheral sensitization, inflammatory mediators, intense/repetitive/prolonged noxious stimulus

Question 21

What is pain modulation?

Answer 21

dynamic process- can occur at multiple levels of the ascending and descending pathway

Question 22

What is neuronal sensitization?

Answer 22

arise when neurotransmitters are left to linger in the synapse
-due to failure in diffusion, enzymatic destruction, and reuptake

Question 23

What does neuronal sensitization do?

Answer 23

prolong the effect of the post-synaptic neurons, allow subthreshold input to recruit a response, spontaneous discharge, and increase the size of receptive field

Question 24

What is normal input of neuronal sensitization?

Answer 24

increased responsiveness of nociceptive neurons

Question 25

What is the the subthreshold input of neuronal sensitization?

Answer 25

recruitment of a response

Question 26

What is spontaneous discharge of neuronal sensitization?

Answer 26

increased size of receptive field

Question 27

What is peripheral sensitization?

Answer 27

nociceptive neurons at periphery of receptive field -increased responsiveness of noiceptive neurons

Question 28

What is reduced threshold to stimulation?

Answer 28

primary hyperalgesia

Question 29

What is hyperalgesia?

Answer 29

an increased pain experience in response to a painful stimulus

Question 30

What is central sensitization/

Answer 30

nociceptive neurons in the central nervous system

Question 31

What is allodynia?

Answer 31

pain resulting from a stimulus that does not normally provoke pain

Question 32

What can cause allodynia?

Answer 32

dysfunctional endogenous pain control

Question 33

What is the revised gate control theory?

Answer 33

myelinate non-nociceptive affect fiver can activate inhibitory interneurons modulating nocicpective transmition

Question 34

What does revised gate control theory do?

Answer 34

instinctively wave, hold, clench, your fingers when they burn

Question 35

What is diffuse noxious inhibitor control?

Answer 35

thresold for nociception can be raised when another noxious stimulus is provoke in another pain area -pain inhibits painWh

Question 36

What is the placebo effect?

Answer 36

psychological -leads to released of endogenous analgesic substance

Question 37

What are the different ways to categorize different pain?

Answer 37

neurophysiology, structures involved, timing

Question 38

What is nocieptive pain?

Answer 38

-pain resulting form damage or threatened damage to non-neural tissue -activation of nociceptor

Question 39

What is neuropathic pain?

Answer 39

-pain resulting from the presence of a lesion or disease of the somatosensory nervous system

Question 40

What is nociplastic pain?

Answer 40

-new concept -pain that arises from altered nociception -does not satisfy the defintions of nociceptive or neuropathic pain -possible for a patient to present with nociceptive and nociplastic pain at the same time

Question 41

What is acute pain?

Answer 41

pain with close temporal relationship to a stimulus, injury, or disease -tends to respond to treatment in a linear dose-dependent fashion

Question 42

What is chronic pain?

Answer 42

more than 3 months -does not typically respond to treatment in a linear dose-dependent fashion -presence of other/multiple ongoing pains is a predictor for transition from acute to chronic -more influence of psychosocial factor -more difficult to treat

Question 43

Most common psychosocial disorders?

Answer 43

-anxiety -major depression -personality disorders -pain distress

Question 44

What are coping mechanisms for psychological disorders?

Answer 44

-internal locus of control -perceived control -catastrophic thinking -hypervigilance -fear avoidance

Question 45

What are the assessments for pain?

Answer 45

-pain intensity -pain distress -pain-related interference (functional limitation, disability) -oral habits

Question 46

What is homotopic pain?

Answer 46

when the site of the pain is the source of the pain

Question 47

What is heterotropic pain?

Answer 47

when the site of the pain is not the source

Question 48

What is central pain?

Answer 48

source is central but percieved peripherally

Question 49

What is projected pain?

Answer 49

pain follows same nerve distribution as primary source

Question 50

What is referred pain?

Answer 50

pain in different nerve than primary source and is spontaneous -not aggravated by palpation -does not respond to anesthesia -does not cross midline

Question 51

What is the most important part of pain management?

Answer 51

understanding why the patient is in pain

Question 52

What are examples of opioids?

Answer 52

codeine, oxycodone, morphine, hydromorphone, and meperidine