Orofacial Pain Flashcards
What length of time makes something chronic?
Longer than 3 months
Peripheral sensitisation is characterised by:
Inflammation and organic damage
Central sensitisation is characterised by:
Plasticity and receptor changes
What are pain receptors called?
Nociceptors
What are the two fibers which carry pain info
- A delta fibers
- C fibers
What info do A-alpha and A-beta carry?
A-Alpha = proprioception
A-Beta = Touch
List 5 salivary causes of non-odontogenic orofacial pain
- Obstruction
- Infection
- Trauma
- Tumours
- Systemic disorders eg Sarcoidosis, Sjogrens
List 3 vascular causes of orofacial pain
- Migraine
- Giant Cell Arteritis
- Cluster Headache
List 4 bone causes of orofacial pain
- Osteitis
- BRONJ
- Trauma
- Pagets Disease
In addition to salivary, vascular, bone causes of orofacial pain, what else might be a non-odontogenic cause
- Sinusitis
- TMD
- Neurological pain
- Infeciton (eg post-herpetc neuralgia)
- Psychogenic
- Referred pain
*
Burning Mouth Syndrome is an example of psychogenic orofacial pain
True or false
True
Most prevalent headache in the general population:
Tension Type Headache
Multi-focal, granulomatous vasculitis of cranial arteries, especially the superficial temporal artery
Temporal Arteritis
central sensitisation can be a feature of TMD and headache conditions
True or false
True
TMD is influenced by genetics
True or false
True
Acute maxillary sinusitis is most commonly caused by:
Viral infections of the URT
5 signs, and 4 symptoms of acute maxillary sinusitis:
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
Tx for acute maxillary sinusitis:
- Removal of identifiable cause
- Rest and recupe
- Head elevation
- Analgestic and antibiotics (if needed)
- Nasal decongestants
What radiographic changes might indicate chronic maxillary sinusitis
Polyps or thickening
What two pathologies might be seen in the maxillary sinus on an OPG
Cysts and polyps.
Can become infected or destroy bone.
Mangement of maxillary sinus cysts and polyps:
Monitor periodically. Most benign.
If in doubt refer.
When dealing with mystery upper molar pain yo should always consider:
Maxillary sinusitis
Innervated by same V2 branch as PSA so pain gets confused.
Most common tx for persistent idiopathic facial pain is:
Low dose antidepressants
What is diabetic odontalgia?
Patients more likely to complain of tooth pain particularly when diabetes not well controlled
Sleep bruxism is thought to be related to psychosocial disorders
True or false
False. Wake clenching is though.
What causes a click on opening?
Condyle gets stuck behind the disc then moves past it
Why do we aim to treat symptoms of TMD rather than treat them anatomically
Because anatomical appearance doesn’t seem to reflect TMD symptoms
Why is it a good idea to take OPG for TMD issues?
Rule out other causes
What are occlusal splints used for in TMD?
To provide symptomatic relief only. THey the equivalent of a crutch - provides relief while patient heals
What two roles do occlusal splints have?
- Improve TMD symptoms
- Protect occlusal surfaces of teeth and dental restos from bruxxing forces
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.
Why should hard splints not be used for TMD?
Hard to fit and not as comfortable. Only use hard for bruxism.
Initial therapy for TMD:
- Education
- Counselling
- Moist heat/cold alternation
- Soft diet - blended if poss
- Rest jaw
- Analgesics
- If it doesn’t improve - splint
How long should you monitor TMD before referring?
6 weeks
What is the gold standard for looking at the TMJ?
MRI
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
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
Chronic pain sufferers arex more likely to have anxiety/depression
4x
What are 4 comorbidities associated with TMD
- Headaches
- Ear symptoms
- Chronic pain conditions eg fibromyalgia
- Anxiety/depression
List 4 neurotransmitters associated with chronic pain
- GABA
- Glutamate
- Norepinephrine
- Serotonin
Common signs and symptoms of TMD:
- Pain in the muscles and TMJ
- Limitation of mouth opening, deviation and deflection
- TMD sounds
What study showed there are links between TMD and genes?
5 techniques for management of chronic pain
- Mindfulness based stress reduction
- Reduce catastrophising
- Exercise
- Sleep hygiene
- Love and reward pathway
Malocclusion is a risk factor for TMD
True or false
False.
List 2 anti-inflammatories used for TMD pain:
- Ibuprofen
- Naproxen
List 1 muscle relaxant used for TMD
Baclofen
List TCAs and SNRIs used for chronic pain management:
- Amitriptiline
- Nortriptiline
- Doxepine
- Duloxetine
List 3 Anti-convulsants used in TMD pain management
- Gabapentin
- Carbamazepine
- Pregabalin
How do medication, oral appliances, self help and physio help with pain?
Act on sensitisation by changing signalling to the brain
