Orofacial Pain Flashcards

1
Q

What are the 4 major causes of orofacial pain?

A
  1. Dentoalveolar
  2. Musculoskeletal
  3. Neuropathic
  4. Neurovascular
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2
Q

What are the subtypes of dentoalveolar causes of orofacial pain?

A
  • Dental pain
  • Periodontal pain
  • Abscess
  • CTS
  • Maxillary sinusitis
  • Salivary gland diseases
  • Oral mucosal diseases
  • Neoplasias
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3
Q

What are the types of MSK orofacial pain?

A

TMD

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4
Q

What are the types of neuropathic pain?

A
  • Trigeminal neuralgia
  • Glossopharyngeal neuralgia
  • BMS
  • Postherpetic neuralgia
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5
Q

What are the types of neurovascular pain?

A
  • Migraines (with or without aura)
  • Headaches (e.g.: cluster)
  • Temporal arteritis
  • Paroxysmal hemicranias
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6
Q

What are the clinical features of trigeminal neuralgia?

A
  • Sharp, stabbing, electric shock-like pain
  • Unilateral
  • Lasts from a few seconds to two minutes
  • Pain is set off by innocuous stimuli
  • After initial episode, the same stimulus pay not cause pain for a while
  • Rarely wakes patient up at night (unless you’re maybe sleeping on the affected side)
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7
Q

What are the investigations you’d undertake for trigeminal neuralgia and why?

A

MRI or CT scan to exclude:

  • neurovascular compression
  • MS
  • tumour
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8
Q

What is the first-line treatment for trigeminal neuralgia?

A
  • Carbemazepine (or Oxcarbazepine for 2nd line), gabapentin, pregabalin, Na valproate
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9
Q

What are the invasive, surgical treatment options for TN?

A
  • Microvascular decompression
  • Percutaneous rhizotomy (destroys part of the nerve that’s causing pain)
  • Stereotactic radiotherapy
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10
Q

What are the positives and negatives of microvascular decompression?

A
  • MVD is the only non-ablative (tissue-destroying) procedure
  • Has demonstrated the greatest improvement in life quality (60-70% of patients remaining pain free at 10-20 years)
  • However, it is the most invasive treatment
  • Mortality rates b/w 0.2-0.5%
  • 5% of cases have permanent ipsilateral hearing loss
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11
Q

What are the subtypes of trigeminal neuralgia?

A
  1. Classical (attributed to nerve compression)
  2. Secondary (attributed to underlying disease - MS)
  3. Idiopathic (no known cause)
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12
Q

What do you have to remember to do after prescribing carbamazepine to TN patients?

A

Perform a baseline haematological, renal and hepatic testing.

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13
Q

What are the clinical features of glossopharyngeal neuralgia?

A
  • Pain on swallowing (giveaway to separate from TN)
  • Sharp pain in ear and tonsils
  • Aggravating stimuli may be - coughing, yawning, swallowing
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14
Q

What tests should you perform to diagnose GN?

A
  • OPG and CBCT (to check for Eagle’s syndrome)
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15
Q

What is the aetiology of postherpectic neuralgia?

A
  • Activation of latent varicella zoster (shingles)
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16
Q

Who usually gets postherpetic neuralgia?

A

Mostly older patients (>60)

17
Q

What are the clinical features of postherpetic neuralgia?

A
  • Unilateral
  • Prodromal skin rash
  • Burning, itching sensation 24-48 hours prior
  • Eruption of vesicles and crusting

(all this can then lead to postherpetic neuralgia)

18
Q

What are the clinical features of BMS?

A
  • Burning, peppery sensation
  • Dysgeusia
  • Xerostomia
  • Halitosis
19
Q

What is the first-line treatment for BMS?

A

Topical Clonazepam

20
Q

What are some other treatment methods for BMS?

A
  • Vitamin B12 supplementation
  • Alpha-lipoic acid
  • palmitoylethanolamide
  • low-level laser therapy
  • capsaicin mouthwash
21
Q

Define migraine (with/without aura)

A

Severely debilitating throbbing headache (usually unilateral), presenting with phonophobia (sounds) and photophobia (light)

22
Q

What is the etiology of migraines?

A
  • Alcohol
  • Oral contraception
  • Genetic
23
Q

What are the clinical features of migraines?

A
  • Unilateral headache
  • Sharp, debilitating
  • Photophobia/phonophobia
  • Aura (flashing lights)
24
Q

What is the treatment for migraines?

A
  • Avoid the trigger
  • Relaxation, tx symptoms (dark quiet room)
  • Pharmacological:
    Acute relief: NSAIDs, antihistamine, prednisolone, opiods, serotonin antagonists
    Preventive: Antidepressants, proponolol (beta blockers), anticonvulsants
25
Q

What is a paroxysmal hemicrania?

A

Unilateral, severely debilitating headache around the eye area

26
Q

What is the treatment for paroxysmal hemicrania?

A
  • Indomethacin (NSAID) 25mg per day
27
Q

What is temporal arteritis?

A

Inflammation of the temporal artery

28
Q

What are the presenting features of temporal arteritis?

A
  • Pain on chewing

- Pain in jaw and tongue

29
Q

What are the treatment options for temporal arteritis?

A
  • Haematology (ESR very high, C-reactive protein)
  • Temporal artery Biopsy
  • Corticosteroids (prednisolone 40-60mg)
30
Q

Describe cardiac tooth pain?

A
  • Constant aching
  • Generally of the left hand side jaw
  • Potentially including the arms / shoulder
  • *Not necessarily occurring with chest pain
  • Aggravated by exercise
  • *Not relieved by local anesthetic
31
Q

How do you diagnose Mx sinusitis?

A
  • Pt exam

- CT scan (gold standard)

32
Q

What is the treatment for Mx sinusitis?

A
  • Antihistamines
  • Decongestants
  • Nasal sprays
  • Antibiotics