Orofacial Pain Flashcards
Structures in the oral cavity and maxillofacial region (11)
- Teeth
- Gingiva
- Mucosa
- Salivary glands
- Muscles
- Bone
- Ligaments
- Tendons
- Blood and lymphatic vessels
- Taste buds (special sensory)
- Nerves (motor and sensory)
— is the most prevalent pain in the facial region.
Toothache (odontalgia)
–% reported a history of toothache in the previous 6-month period.
12 to 14
Not all pains are the —.
Not all toothaches are the —.
And not all toothaches are in fact toothaches (i.e., odontalgia).
sam same
Odontogenic (2)
- Pulpal
* Periodontal
Non-Odontogenic (7)
- Sinus/nasal
- Myofascial
- Neurovascular
- Neuropathic
- Cardiogenic (rare)
- Systemic (rare)
- Idiopathic
Other forms of orofacial pain (5)
- Mucosal Pain
- Temporomandibular Disorders
- Orofacial Neuropathic Pain
- Neurovascular Pain (Headaches)
- Sleep Disorders* (not really pain)
TMJ
• Prevalence
General population – F:M /
Patient population – F:M /
6: 4
7. 5:1
TMJ
• Bimodal distribution
More prevalent in
younger adults & older adults
• TMD involving joint sounds
35% have — TM joint sounds
3.6-7.0% — TM joint sound
asymptomatic
symptomatic
TMJ
• Fluctuating, remitting, self-limiting
— uncommon
progression
“Unpleasant sensory and emotional experience
associated with actual or potential tissue damage
or described in terms of such damage”
pain
Why do we feel pain?
Instills protective behavior
but if unabated, pain can be harmful
Principles of pain (3)
• It is always subjective.
• It may or may not be tied to a stimulus.
• It is always a consequence of an emotional
experience and psychological state
How do we experience pain (usually)? (5)
• Environmental stimulus (thermal, mechanical, chemical, polymodal)
• Receptor activation
• Generation of action potential
• Transmission through primary afferent to dorsal horn (trigeminal spinal track nucleus)
• Projection from dorsal horn/TSTN to brain for perception and interpretation
Pain location, intensity, reflexes, and meaning (supraspinal structures)
“--- is not pain until it reaches and is processed by higher centers (supraspinal structures)"
Nociception
Descending Pathway (2)
Spinal
Supraspinal
Spinal (2)
- Endogenous opioid signaling.
* Non-opioid inhibitory neurotransmitters.
• Non-opioid inhibitory neurotransmitters. (4)
Serotonin
Noradrenaline
GABA
Glycine
Supraspinal
- Influenced by psychological factors.
- Neurons from the cortex and amygdala.
- Periaqueductal gray & rostroventral medulla
Pain Modulation
Dynamic process – can occur at multiple levels
of the ascending and descending pathways.
modulation (3)
supraspinal
spinal
peripheral
Neuronal Sensitization
• Arises when
neurotransmitters are left to linger in the synapse.
- Due to failure(s) in diffusion, enzymatic destruction, reuptake.