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BDS4 > 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
  • EMLA
  • 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 ?

A
22
Q

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

A

REFER

23
Q

What 3 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
Q

What will you use to monitor persistent idiopathic facial pain?

A
  • QOL or pain scores
26
Q

What is oral dysaesthesia?

A

An abnormal sensory perception in the mouth in the absence of abnormal stimuli

27
Q

What symptoms might a women with oral dysaesthesia experience?

A
  • Burning or nipping feeling
  • Dysgeusia - abnormal taste sensation
  • Paraesthesic feeling
  • Dry mouth feeling
28
Q

4 Predisposing factors to oral dysaesthesia?

A
  • Deficiencies - haematinics, zinc , b1 and b6
  • Fungal and Viral infections
  • Gender - more common in women
  • ANXIETY and stress
29
Q

Burning mouth syndrome is an oral dysaesthesia most likely associated with what?

A

Haematinic deficiency

30
Q

If oral dysaesthesia symptoms is affecting only the lips and the tips of the tongue, what might be the cause?

A

Parafunctional habits

31
Q

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 ?

A

Dysgeusia

32
Q

Which 3 conditions might cause dysgeusia?

A
  • Chronic sinusitis
  • Perio and dental infection
  • GORD
33
Q

What is touch dysaesthesia?

A

Normal touch sensation is perceived as pins and needles or tingling

34
Q

A patient present with touch dyaesthesia , what 3 things do you want to exclude and what special investigations?

A
  • Organic neurological disease
  • Infection and tumours
  • Do Cranial nerves test
  • Do MRI to check for demyelination or tumour
35
Q

What is Dry mouth dysaesthesia usually associated with?

A

Anxiety disorders

36
Q

How would you manage dysaesthesia?

A
  • 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
Q

What anxiolytic medications are used to manage oral dysaesthesia?

A
  • Nortriptyline
  • Mirtazepine
  • Vortioxetine
38
Q

3 meds to manage neuropathic symptoms in oral dysaesthesia?

A
  • Gabapentin / pregabalin
  • Clonazepam
39
Q

3 ways to classify patient with TMD?

A
  • Joint degeneration - pain on use and crepitus
  • Internal derangement - locking ( open or closed)
  • No joint pathology
40
Q

4 things which may cause TMD ?

A
  • Occlusion
  • Grinding
  • Clenching
  • Stress- anxiety
41
Q

5 physical signs in TMD you want to look for?

A
  • Clicking joint
  • Locking with reduction
  • Limitation of opening mouth
  • tenderness of MoM
  • tenderness in cervico-cranial muscles
42
Q

5 questions you would ask a patient to investigate TMD?

A
  • 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
Q

3 types of muscles you examine in TMD?

A
  • Masticatory
  • Sternomastoid
  • Trapezius
44
Q

What does crepitus indicate in relation to TMD ?

A

Degenerative disease

45
Q

What does clicking indicate in case of TMD?

A

Muscle dysfunction

46
Q

When might an ultrasound be indicated to investigate TMD?

A

If functional visualisation of disc movement is needed

47
Q

When might a digital panoramic tomography or CBCT be indicated for TMD?

A

If a bony problem was suspected

48
Q

What image is considered the best for the articular disc when investigating TMD?

A

MRI

49
Q

If you want to directly visualise the disk , what is this called?

A

Arthroscopy

50
Q

5 management options TMD?

A
  • Counselling
  • Physical therapy
  • Analgesia
  • Medications - TCA
  • Acupuncture
  • Therapy

BDS4 (63 decks)

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