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ORAL MEDICINE > OROFACIAL PAIN > Flashcards

OROFACIAL PAIN Flashcards

1
Q

Biopsychosocial factors of pain:

A

1) Patient characteristics eg. genetics, sex, depression, cognition
2) Environment eg. upbringing, lifestyle socialisation
3) Disease eg. history or present disease

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2
Q

Types of orofacial pain

A 
Temperomandibular disorders (TMD) or temperomandibular joint dysfunction syndrome (TMJDS)
Persistent idiopathic facial pain (PIFP)
Atypical odontalgia
Burning mouth syndrome
Glossopharyngeal neuralgia (9)
trigeminal neuralgia (5)
Shingles
Headaches
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3
Q

what does chronic/persistent mean

A

> 3 months

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4
Q

TemperoMandibularDisorder meaning+examples

A 
TMD means musculoskeletal disorder of the TMJ+MOM
eg. 
myofascial pain disorder
TMJ disc interference disorder
TMJ degenerative joint disease
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5
Q

risk factors of TMJD

A
  • depression/psychological distress
  • multiple pain conditions eg. RA, chronic back pain, irritable bowl syndrome
  • female
  • bruxism
  • facial trauma
  • sleep problems
  • exogenous hormone use eg. OCP
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6
Q

Pain history of TMJD

A

Site/radiation: uni/bilateral TMJ, MOM, pre/post auricular
Character: dull, aching, throbbing
Associations: clicking, stress, tender muscles
Relive: rest+analgesics
Provoke: chewing, yawning, opening wide
Duration: intermitent/constant
Severity: mild-moderate

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7
Q

TMJ disc problems cause:

A

trismus/reduced opening

deviation on opening

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8
Q

Indications of a DEGENERATIVE disease eg. TMJ degenerative joint disease are a combination of:

A 
clicking
crepitus
limitation of movement-locking
sudden inability to fully close teeth
momentary hesitation during movement
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9
Q

TREATMENT FOR TMJD (self care, drug, adjuncts)

A

SELF CARE

  • warmth to joints
  • jaw massages+exercises
  • attention to parafunctional habits eg. bruxism
  • relaxation
  • empowerment

DRUGS:

  • analgesics: NSAIDs, paracetamol, opioids
  • Corticosteroids
  • Anxiolytics
  • Anti-depressants
  • Sedative eg. BDZ sedative and anxiety
  • Muscle relaxants

AJUNCTS

  • acupuncture
  • CBT
  • Physiotherapy
  • Splint therapy
  • Botox injection
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10
Q

cognitive-behavioural therapy and best candidates for it

A
  • proved to help with depression
  • decreases maladaptive response and increases adaptive response
  • how to challenge negative thoughts about pain

BEST CANDIDATES:

  • motivated
  • catastophize
  • highly distressed
  • somatization- have physical response
  • self-efficacy
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11
Q

Acupuncture

A 
-Stomach 7 point
inferior to zygomatic arch
anterior to condyle
TENDER point of masseter
high density of nerve endings
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12
Q

Overview of managing TMJD

A

1) Conservative measure eg. aware of parafunctional habits/no sticky toffees
2) pain with neuropathic/atypical component= Tricyclic antidepressants
3) Mucoskeletal pain=NSAIDs/BDZ=sedative+anxiety
3) Pain+psychosocial dysfunction= CBT antidepressants and psychosocial assessment

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13
Q

Persistent idiopathic facial pain (PIFP)

Atypical facial pain

A
  • Diagnosis of exclusion
  • widely radiated + poor localisation
  • history of chronic prolonged dental pain+ unsuccessful interventions
  • may lead to multiple extractions and pain not resolving
  • severe dental infections
  • stress during a major life event
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14
Q

Features associated with persistent idiopathic facial pain

risk factors

A

Inflammatory bowl syndrome-IBS
Neck and back ache
dysmenorrhea

risk factors:
genetic
female
passive coping traits

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15
Q

Pain history of PIFP

A

Site/radiation: no anatomical area, widespread and poorly localised, h&n and down the arms
Character: dull throbbing aching
Associated: IBS, neck and back pain, major stress life event
Duration: intermittent/constant
Alleviating factors: relaxing and rest (NOT ANALGESICS)
Provoking: chewing, stress, cold water, dental stress
Severity: mild-severe

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16
Q

Atypical odontalgia

A
  • pain in tooth/edentulous alveolar ridge with no radiographic/clinical signs
  • overlap with PIFP but more localised
  • dental intervention seems to have initiated this atypical odontalgia
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17
Q

Atypical odontalgia symptoms

A

persistent, intense oral pain
initiation seems to be due to dental intervention
overlap with PIFP but more localised
any tooth/extraction site but pain seems to move to neighbouring teeth
maxillary molars and premolars are most common

18
Q

Management of atypical odontalgia

A

convince the pt nothing is wrong
stop ongoing dental interventions+XLA bc pain can move from tooth to tooth and noth is wrong
topical lidocaine 5%
Systemic tricyclic antidepressants eg. amytriptylline

19
Q

When do we use tricyclic antidepressants and give an example

A

eg. amitriptylline
- atypical odontalgia
- TMD with pain with neuropathic/atypical components

20
Q

Burning mouth syndrome

A

idiopathic burning pain/discomfort sensation of the mouth with NORMAL oral mucosa and all other medical/dental diagnosis have been excluded

21
Q

BMS vs SYMPTOMS

A

Syndrome= every medical/dental diagnosis has been excluded

symptoms
local-> mucosal diseases (LP,LR,DLE,GVHD) blisters (PV,MMP,HSV)
Systemic-> Haematinic deficiencies, GIT crohns/coeliac, medication eg. ACE/b-blockers

22
Q

BMS pain history

A

Site/radiation: tongue/lips/gingiva/palate
Character: burning smarting annoying
Associated: xerostomia, altered taste, tongue thrusting, anxiety
Relieves: distraction, rest, eating yogurt
Provokes: stress some foods
Duration: Continuous/intermittent worse pm
Severity: mild-moderate

23
Q

Key associations to BMS

A

Xerostomia
altered taste
tongue thrusting
common in women w menopause

24
Q

Reasons for BMS

A

1) hormonal
- menopause reduces: gonadal+neuroactive steroids
- anxiety/stress can impair HPA axis reducing adrenal steroid levels
- loss of neuroprotective effects
- oral nerve terminal neurodegenerative changes

25
Q

Reasons for dysgeusia in BMS

A
  • neuropathic changes effects gustatory nervous system - partic chorda tympani
  • Removes inhibitory control of somatic small fibre nerve afferents responsible for burning sensation
  • Release of inhibition of glossopharyngeal nerve resulting in taste phantoms and alterations in touch and pain
  • more likely to be supertasters
26
Q

Management of BMS

A
  • exclude all medical/dental possible diagnosis
  • strongly reassure that its not cancer
  • symptomatic- salivary substitutes eg. carboxymethyl cellulose and difflam 0.15%
  • tricyclic antidepressants eg. amytriptylline/ antidepressants eg. SSRI eg. fluoxetine
  • CBT
  • Alphalipoicacid,gabapentin,clonazepam
27
Q

Glossopharyngeal neuralgia

A

CN 9
unilateral
severe transient stabbing pain at EAR, base of tongue, beneath angle of jaw
initiated by chewing/talking/swallowing/coughing

28
Q

Aetiology of glossopharyngeal neuralgia

A
  • compression of cranial nerve 9

- congenital vascular anomalys/tumor/aneurysm

29
Q

Eagle syndrome

A

differential of glossopharyngeal neuralgia
elongated styloid process
symptoms: shooting pain involving ear, jaw, base of tongue
treatment: styloidectomy

30
Q

Management of glossopharyngeal neuralgia

A
  • decompression of nerve

- medication like trigeminal neuralgia

31
Q

Trigeminal neuralgia

A

sudden unilateral severe stabbing recurrent pain in one or more branches of the trigeminal nerve (5th CN)

32
Q

Risk factors of trigeminal neuralgia is

A

multiple sclerosis

hypertension

33
Q

trigeminal neuralgia classification

A

IDIOPATHIC
typical
atypical

SECONDARY
intrinsic brainstem pathology -MS
Extrinsic cerebellopontine angle pathology- posterior fossa tumors

34
Q

Pain history of trigeminal neuralgia

A

Site/Radiation: Trigeminal nerve distribution, normally unilateral (if its bilateral consider MS) normally V2/3
Character: sharp shooting terrifying
Associated: MS, hypertension, TRIGGER ZONES
Eleviating: avoiding touch, sleeping, anti-convulsants
Provoking: touching esp trigger zones, eating, talking, spontaneous
Duration: bouts lasts for seconds- complete remission weeks/months
Severity- moderate-severe

35
Q

Trigeminal neuralgia investigations

A
  • FBC
  • MRI posterior fossa (check for a tumor)
  • CT scan if nothings on the MRI to detect MS+tumors
  • LFT
36
Q

Aetiology of trigeminal neuralgia

A 
idiopathic
cerebellar artery compressing nerve root at root entry zone
compression of the nerve at the REZ:
tumor
cerebellar artery
demyelination plaques
37
Q

Trigeminal neuralgia and multiple sclerosis

A

bilateral

38
Q

Treatment of trigeminal neuralgia

A

CARBAMEZIPINE- anticonvulsant
300-800mg 1-4 times a day

trigeminal nerve surgery

39
Q

Carbamezipine side effects

A

tired
zombie feeling
diplopia
nausea

40
Q

Summary of aetiology of trigeminal neuralgia

A 
idiopathic
compression at the root entry zone due to:
trauma
cerebellar artery
plaque demyelination
41
Q

Trigeminal neuralgia progression

A

beginning more periods of remission and less exacerbation
middle less remission
end no remission only exacerbation

ORAL MEDICINE (12 decks)

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