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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.

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
Most common tx for persistent idiopathic facial pain is:
Low dose antidepressants
26
What is diabetic odontalgia?
Patients more likely to complain of tooth pain particularly when diabetes not well controlled
27
Sleep bruxism is thought to be related to psychosocial disorders True or false
False. Wake clenching is though.
28
What causes a click on opening?
Condyle gets stuck behind the disc then moves past it
29
Why do we aim to treat symptoms of TMD rather than treat them anatomically
Because anatomical appearance doesn't seem to reflect TMD symptoms
30
Why is it a good idea to take OPG for TMD issues?
Rule out other causes
31
What are occlusal splints used for in TMD?
To provide symptomatic relief only. THey the equivalent of a crutch - provides relief while patient heals
32
What two roles do occlusal splints have?
* Improve TMD symptoms * Protect occlusal surfaces of teeth and dental restos from bruxxing forces
33
Occlusal splints are more useful for patients with disc related TMD True or false
False. More useful for myogenic BUT can be useful for both.
34
Why should hard splints not be used for TMD?
Hard to fit and not as comfortable. Only use hard for bruxism.
35
Initial therapy for TMD:
* Education * Counselling * Moist heat/cold alternation * Soft diet - blended if poss * Rest jaw * Analgesics * If it doesn't improve - splint
36
How long should you monitor TMD before referring?
6 weeks
37
What is the gold standard for looking at the TMJ?
MRI
38
What is the difference between nociceptive and neuropathic pain?
* 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
What is the concept of sensitisation?
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
Chronic pain sufferers arex more likely to have anxiety/depression
4x
41
What are 4 comorbidities associated with TMD
1. Headaches 2. Ear symptoms 3. Chronic pain conditions eg fibromyalgia 4. Anxiety/depression
42
List 4 neurotransmitters associated with chronic pain
* GABA * Glutamate * Norepinephrine * Serotonin
43
Common signs and symptoms of TMD:
* Pain in the muscles and TMJ * Limitation of mouth opening, deviation and deflection * TMD sounds
44
What study showed there are links between TMD and genes?
45
5 techniques for management of chronic pain
* Mindfulness based stress reduction * Reduce catastrophising * Exercise * Sleep hygiene * Love and reward pathway
46
Malocclusion is a risk factor for TMD True or false
False.
47
List 2 anti-inflammatories used for TMD pain:
* Ibuprofen * Naproxen
48
List 1 muscle relaxant used for TMD
Baclofen
49
List TCAs and SNRIs used for chronic pain management:
* Amitriptiline * Nortriptiline * Doxepine * Duloxetine
50
List 3 Anti-convulsants used in TMD pain management
* Gabapentin * Carbamazepine * Pregabalin
51
How do medication, oral appliances, self help and physio help with pain?
Act on sensitisation by changing signalling to the brain
52

Oral Pathology/Oral Medicine (22 decks)

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