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Oral Pathology/Oral Medicine > Orofacial Pain > Flashcards

Orofacial Pain Flashcards

1
Q

What length of time makes something chronic?

A

Longer than 3 months

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2
Q

Peripheral sensitisation is characterised by:

A

Inflammation and organic damage

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3
Q

Central sensitisation is characterised by:

A

Plasticity and receptor changes

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4
Q

What are pain receptors called?

A

Nociceptors

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5
Q

What are the two fibers which carry pain info

A
  • A delta fibers
  • C fibers
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6
Q

What info do A-alpha and A-beta carry?

A

A-Alpha = proprioception

A-Beta = Touch

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7
Q

List 5 salivary causes of non-odontogenic orofacial pain

A
  • Obstruction
  • Infection
  • Trauma
  • Tumours
  • Systemic disorders eg Sarcoidosis, Sjogrens
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8
Q

List 3 vascular causes of orofacial pain

A
  • Migraine
  • Giant Cell Arteritis
  • Cluster Headache
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9
Q

List 4 bone causes of orofacial pain

A
  • Osteitis
  • BRONJ
  • Trauma
  • Pagets Disease
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10
Q

In addition to salivary, vascular, bone causes of orofacial pain, what else might be a non-odontogenic cause

A
  • Sinusitis
  • TMD
  • Neurological pain
  • Infeciton (eg post-herpetc neuralgia)
  • Psychogenic
  • Referred pain
    *
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11
Q

Burning Mouth Syndrome is an example of psychogenic orofacial pain

True or false

A

True

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12
Q

Most prevalent headache in the general population:

A

Tension Type Headache

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13
Q

Multi-focal, granulomatous vasculitis of cranial arteries, especially the superficial temporal artery

A

Temporal Arteritis

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14
Q

central sensitisation can be a feature of TMD and headache conditions

True or false

A

True

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15
Q

TMD is influenced by genetics

True or false

A

True

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16
Q
A
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17
Q

Acute maxillary sinusitis is most commonly caused by:

A

Viral infections of the URT

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18
Q

5 signs, and 4 symptoms of acute maxillary sinusitis:

A

Symptoms

  • Cheek pain
  • Increased pain on lowering of head
  • Increase pain on jarring
  • Maxillary dental pain or pressure
  • Concomittant nasal obstruction

Signs

  • Pain on pressure on anterior maxillary wall
  • Purulent discharge
  • Fever
  • Malaise
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19
Q

Tx for acute maxillary sinusitis:

A
  1. Removal of identifiable cause
  2. Rest and recupe
  3. Head elevation
  4. Analgestic and antibiotics (if needed)
  5. Nasal decongestants
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20
Q

What radiographic changes might indicate chronic maxillary sinusitis

A

Polyps or thickening

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21
Q

What two pathologies might be seen in the maxillary sinus on an OPG

A

Cysts and polyps.

Can become infected or destroy bone.

22
Q

Mangement of maxillary sinus cysts and polyps:

A

Monitor periodically. Most benign.

If in doubt refer.

23
Q
A
24
Q

When dealing with mystery upper molar pain yo should always consider:

A

Maxillary sinusitis

Innervated by same V2 branch as PSA so pain gets confused.

25
Q

Most common tx for persistent idiopathic facial pain is:

A

Low dose antidepressants

26
Q

What is diabetic odontalgia?

A

Patients more likely to complain of tooth pain particularly when diabetes not well controlled

27
Q

Sleep bruxism is thought to be related to psychosocial disorders

True or false

A

False. Wake clenching is though.

28
Q

What causes a click on opening?

A

Condyle gets stuck behind the disc then moves past it

29
Q

Why do we aim to treat symptoms of TMD rather than treat them anatomically

A

Because anatomical appearance doesn’t seem to reflect TMD symptoms

30
Q

Why is it a good idea to take OPG for TMD issues?

A

Rule out other causes

31
Q

What are occlusal splints used for in TMD?

A

To provide symptomatic relief only. THey the equivalent of a crutch - provides relief while patient heals

32
Q

What two roles do occlusal splints have?

A
  • Improve TMD symptoms
  • Protect occlusal surfaces of teeth and dental restos from bruxxing forces
33
Q

Occlusal splints are more useful for patients with disc related TMD

True or false

A

False.

More useful for myogenic BUT can be useful for both.

34
Q

Why should hard splints not be used for TMD?

A

Hard to fit and not as comfortable. Only use hard for bruxism.

35
Q

Initial therapy for TMD:

A
  • Education
  • Counselling
  • Moist heat/cold alternation
  • Soft diet - blended if poss
  • Rest jaw
  • Analgesics
  • If it doesn’t improve - splint
36
Q

How long should you monitor TMD before referring?

A

6 weeks

37
Q

What is the gold standard for looking at the TMJ?

A

MRI

38
Q

What is the difference between nociceptive and neuropathic pain?

A
  • Nociceptive - caused by activity in neural pathways in response to potentially tissue damaging stimuli
  • Neuropathic - initiated or caused by primary lesions or dysfunction in the nervous system
39
Q

What is the concept of sensitisation?

A

Neurons in the CNS have the ability to remodel. Existing connections can be enhanced, and new connections can be formed - this is called neuroplasticity. Central sensitisation occurs as a result of this neuroplasticity

40
Q

Chronic pain sufferers arex more likely to have anxiety/depression

A

4x

41
Q

What are 4 comorbidities associated with TMD

A
  1. Headaches
  2. Ear symptoms
  3. Chronic pain conditions eg fibromyalgia
  4. Anxiety/depression
42
Q

List 4 neurotransmitters associated with chronic pain

A
  • GABA
  • Glutamate
  • Norepinephrine
  • Serotonin
43
Q

Common signs and symptoms of TMD:

A
  • Pain in the muscles and TMJ
  • Limitation of mouth opening, deviation and deflection
  • TMD sounds
44
Q

What study showed there are links between TMD and genes?

A
45
Q

5 techniques for management of chronic pain

A
  • Mindfulness based stress reduction
  • Reduce catastrophising
  • Exercise
  • Sleep hygiene
  • Love and reward pathway
46
Q

Malocclusion is a risk factor for TMD

True or false

A

False.

47
Q

List 2 anti-inflammatories used for TMD pain:

A
  • Ibuprofen
  • Naproxen
48
Q

List 1 muscle relaxant used for TMD

A

Baclofen

49
Q

List TCAs and SNRIs used for chronic pain management:

A
  • Amitriptiline
  • Nortriptiline
  • Doxepine
  • Duloxetine
50
Q

List 3 Anti-convulsants used in TMD pain management

A
  • Gabapentin
  • Carbamazepine
  • Pregabalin
51
Q

How do medication, oral appliances, self help and physio help with pain?

A

Act on sensitisation by changing signalling to the brain

52
Q
A

Oral Pathology/Oral Medicine (22 decks)

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