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BDS4 Exam Perp > Orofacial pain > Flashcards

Orofacial pain Flashcards

1
Q

According to the international Association for the Study of pain , what is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

Example for PAIN scoring system?

A

McGill PAIN score

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3
Q

Example of emotional symptoms symptoms scoring system?

A

HAD

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4
Q

Describe the process in which we feel pain? (4)

A
  • Nociceptors detect harmful stimulus
  • This is transferred by peripheral nerves to the spinal cord
  • Modulation happens in the spinal cord
  • These signals are then sent to the brain for conscious perception
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5
Q

Which nerve in the face has a somatic supply?

A

V nerve

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6
Q

What is chronic regional pain syndrome?

A

Delocalised pain that spreads around anatomical boundaries which can be bilateral

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7
Q

How can chronic regional pain often described by patients (3) ?

A
  • Gripping
  • Tight
  • Burning
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8
Q

How are the symptoms of Chronic regional pain syndrome?

A
  • Felling of swelling and heat
  • Colour change in overlying skin
  • Autonomic changes
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9
Q

What is nociceptive pain?

A

A pain caused by an activity in neural pathways in response to potentially tissue damaging stimuli

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10
Q

What is neuropathic pain?

A

A pain caused by primary lesion or dysfunction in the nervous system

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11
Q

5 examples of nociceptive pain?

A
  • post operative pain
  • Sport injuries
  • Sickle cell crisis
  • Arthritis pain
  • Mechanical low back pain
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12
Q

5 examples of neuropathic pain?

A
  • post herpetic neuralgia
  • Trigeminal neuralgia
  • Diabetes
  • HIV
  • Central post stroke pain
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13
Q

Explain 3 symptoms of neuropathic pain?

A
  • Constant burning / aching pain
  • in a fixed location
  • fixed intensity
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14
Q

3 cases where neuropathic pain can occur?

A
  • Can follow facial trauma
  • Can follow extractions
  • Can follow a shingles episode
  • Can follow destrctive treatment for pain
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15
Q

4 General causes of neuropathic pain?

A
  • Medical interventions
  • Genetic predisposition
  • Trauma
  • Disease process- infections, tumours
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16
Q

3 systemic medications for neoropathic pain?

A
  • Pregabalin
  • Gabapentin
  • Tricyclic antidepressants
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17
Q

3 topical medications for neuropathic pain management?

A
  • Topical lidocaine
  • Benzydamine
  • Ketamine
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18
Q

Other than medication what two things can you do to manage neuropathic pain?

A
  • Physical therapy - TENS , acupuncture
  • Psychological therapy - distraction, CBT
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19
Q

What is Atypical odontalgia?

A
  • Dental pain without dental pathology
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20
Q

Describe how atypical odontalgia can present in a patient?

A
  • Episodic with pain free or mild pain periods
  • A pain episode is intense and lasts up to 2-3 weeks
  • Like acute pulpitis pain , goes when extracting but comes back again in adjacent tooth
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21
Q

Management pathway of orodental pain ?

22
Q

A Patient presents with Atypical odontalgia in primary care , how they would be treated?

23
Q

What 2 strategies are there to manage Atypical odontalgia in secondary care?

A
  • Chronic strategy - reduce chronic pain experience
  • Acute strategy - have a plan to control the pain
24
Q

What is presistent idiopathic facial pain?

A

A continuous facial pain which poorly fits into standard chronic pain syndromes and has an autonomic component

25
What will you use to monitor persistent idiopathic facial pain?
* QOL or pain scores
26
What is oral dysaesthesia?
An abnormal sensory perception in the mouth in the absence of abnormal stimuli
27
What symptoms might a women with oral dysaesthesia experience?
* Burning or nipping feeling * Dysgeusia - abnormal taste sensation * Paraesthesic feeling * Dry mouth feeling
28
4 Predisposing factors to oral dysaesthesia?
* Deficiencies - haematinics, zinc , b1 and b6 * Fungal and Viral infections * Gender - more common in women * ANXIETY and stress
29
Burning mouth syndrome is an oral dysaesthesia most likely associated with what?
Haematinic deficiency
30
If oral dysaesthesia symptoms is affecting only the lips and the tips of the tongue, what might be the cause?
Parafunctional habits
31
A patient presents saying they have bad taste , bad smell but on examination you do not find anything that confirms these symptoms , what might this be ?
Dysgeusia
32
Which 3 conditions might cause dysgeusia?
* Chronic sinusitis * Perio and dental infection * GORD
33
What is touch dysaesthesia?
Normal touch sensation is perceived as pins and needles or tingling
34
A patient present with touch dyaesthesia , what 3 things do you want to exclude and what special investigations?
* Organic neurological disease * Infection and tumours * Do Cranial nerves test * Do MRI to check for demyelination or tumour
35
What is Dry mouth dysaesthesia usually associated with?
Anxiety disorders
36
How would you manage dysaesthesia?
* Explain the condition to the patient ( a condition where normal sensation is experiences as painful sensation) * Assess degree of anxiety and advice the patient
37
What anxiolytic medications are used to manage oral dysaesthesia?
* Nortriptyline * Mirtazepine * Vortioxetine
38
3 meds to manage neuropathic symptoms in oral dysaesthesia?
* Gabapentin / pregabalin * Clonazepam
39
3 ways to classify patient with TMD?
* Joint degeneration - pain on use and crepitus * Internal derangement - locking ( open or closed) * No joint pathology
40
4 things which may cause TMD ?
* Occlusion * Grinding * Clenching * Stress- anxiety
41
5 physical signs in TMD you want to look for?
* Clicking joint * Locking with reduction * Limitation of opening mouth * tenderness of MoM * tenderness in cervico-cranial muscles
42
5 questions you would ask a patient to investigate TMD?
* Any chronic pain in the head and neck area? * When does this pain get worse? * Do you have any life stressors? * Occupation? * Any parafunctional habits? such as clenching
43
3 types of muscles you examine in TMD?
* Masticatory * Sternomastoid * Trapezius
44
What does crepitus indicate in relation to TMD ?
Degenerative disease
45
What does clicking indicate in case of TMD?
Muscle dysfunction
46
When might an ultrasound be indicated to investigate TMD?
If functional visualisation of disc movement is needed
47
When might a digital panoramic tomography or CBCT be indicated for TMD?
If a bony problem was suspected
48
What image is considered the best for the articular disc when investigating TMD?
MRI
49
If you want to directly visualise the disk , what is this called?
Arthroscopy
50
5 management options TMD?
* Counselling * Physical therapy * Analgesia * Medications - TCA * Acupuncture * Therapy

BDS4 Exam Perp (72 decks)

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