Oro-Facial Pain

Question 1

Most common oro-facial pain?

Answer 1

Dental pain

Question 2

What can cause dental pain?

Answer 2

Teeth - caries, exposed dentine, plural pain, periodical pain, cracked tooth syndrome

Gingiva - periodontal disease

Bone - osteomyelitis

Question 3

What is chronic pain?

Answer 3

Any pain >3 months

Question 4

How to take pain tx?

Answer 4

SOCRATES

Question 5

What is paroxysms?

Answer 5

Uncontrolled outburst/ sudden attack

Question 6

What are possible characteristics of pain?

Answer 6

Sharp
Shooting
Throbbing
Aching 
Burning

Question 7

What pain questionnaire can be used for pain?

Answer 7

McGill

Question 8

What are possible aggravation or alleviating factors?

Answer 8

Functional activities
Parafunctional activities
Hot/ cold
Sleep 
Analgesia
Stress

Question 9

What % of population have chronic facial pain?

Answer 9

7-14%

Question 10

What are consequences of chronic pain?

Answer 10

Reduced activity
Unhelpful thoughts/ believes
Long term use analgesics
Loss of job 
Stress
Psychological issues

Question 11

What should be included in examination of dental/ oro-facial pain?

Answer 11

E.O - symmetry, lymph nodes, TMJ, cranial nerves
I.O - soft tissue, teeth
S.T

Look, palpate, percuss

Question 12

What would indicate acute pulpits?

Answer 12

Pain difficult to localise
Change w/ time
Hypersensitive to stimuli 
Poor response analgesics 
Vital

Question 13

What would indicated cracked tooth syndrome?

Answer 13

Pain worse on biting

Question 14

What would indicate periodical periodontitis?

Answer 14

Localised pain
Painful to bite
Non-vital tooth

Question 15

What is osteitis?

Answer 15

Deep throbbing pain, bad taste, bad odour, difficulty sleeping

Question 16

What are types of osteitis?

Answer 16

Dry socket = acute alveolitis
Osteomylitis
MRONJ
BRONJ

Question 17

What is good for post-op pain?

Answer 17

inflammatory pain therefore NSAIDs

Mediation by arachidonic acid pathway

Question 18

When is it common to see referred dental pain?

Answer 18

Sinusitis can mimic tooth pain - worse on laying down

Common in headaches

Referral from other quadrants

Question 19

What is maxillary sinusitis?

Answer 19

Constant burning pain w/ zygomatic and dental tenderness from inflammation of maxillary sinus

Question 20

What would you see in pt w/ maxillary sinusitis?

Answer 20

Purulent rhinorrhoea
Recovery nasal cold then worsening of symptom
Purulent discharge nasal cavity
ESR above 10mm/ h

Question 21

What does normal sinus function depend on?

Answer 21

Pt ostia
Satisfactory cillary functioning
Appropriate amount secretions

Question 22

What is aetiology of burning mouth syndrome?

Answer 22

Unknown

Any part of mouth can burn

Question 23

What is aetiology of oral dysasthesia?

Answer 23

Altered sensation - more related to incidence of trauma

e.g surgical XLA

Question 24

How to diagnose BMS/ OD?

Answer 24

Exclusion e.g have they had trauma

Question 25

What is trigeminal neuralgia?

Answer 25

Sudden, usually unilateral, severe, brief, stabbing, recurrent pain in distribution of one or more branches of 5th CN

Question 26

What is atypical facial pain?

Answer 26

Pain present daily and persist most of day

Confined at onset to limited area of one or both side of face but may spread

Question 27

What is atypical facial pain not associated w/?

Answer 27

Sensory loss or other physical signs?

Question 28

What should lab investigation reveal if atypical facial pain?

Answer 28

Shouldn’t demonstrate relevant abnormalities

Question 29

What is atypical odontalgia?

Answer 29

Severe throbbing pain in tooth w/o major pathology

Constant pain which goes on excessively

Question 30

What is tempromandibular joint pain?

Answer 30

Pain in the TMJ and MOM - may worsen upon chewing and lead to restricted jaw movement

Question 31

Other possible causes of oro-facial pain to consider?

Answer 31

Oral cause
Space occupying lesions
Systemic illness
Temporal arteritis
Iatrogenic causes