orofacial pain

Question 1

pain definition

Answer 1

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

Question 2

basics of pain neurophysiology

Answer 2

stimulation of nociceptor (chemical, thermal and mechanical)
transduction
transmission
and modulation
the sum yields the human experience of pain

Question 3

transduction

Answer 3

refers to the activation of specialised nerves, namely, A-delta and C-fibers, that transmit information to the spinal chord

Question 4

classification fo orofacial pain

Answer 4

somatic
neuropathic
psychological

Question 5

somatic

Answer 5

musculoskeletal and visceral structures e.g. musculoskeletal is TMJ or periodontal pain; visceral pain - salivary gland and pulpitis

Question 6

neuropathic

Answer 6

damage or alteration to the pain pathways e.g. trauma or surgery

Question 7

psychological

Answer 7

malingering, psychiatric disturbances

Question 8

acute pain

Answer 8

<6 months

Question 9

chronic pain

Answer 9

> 6 months

Question 10

acute characteristics
1. duration
2. associated cause
3. prognosis
4. nerve conduction
5. associated illness
6. social sequelae
7. treatment

Answer 10

1. hours-days
2. present
3. predictable
4. rapid
5. uncommon
6. few/non
7. primary analgesics

Question 11

chronic characteristics
1. duration
2. associated cause
3. prognosis
4. nerve conduction
5. associated illness
6. social sequelae
7. treatment

Answer 11

1. months-years
2. commonly absent
3. unpredictable
4. slow
5. depression/anxiety
6. often profound
7. ussually multimodal required

Question 12

odontogenic pain

Answer 12

etiological factors of an odontogenic origin e.g. caries, defective restorations, trauma or fractures
responsive to dental treatment
pain reduction by local anaesthetics
unilateral and localised pain
sensitivity to temperature, percussion and digital pressure

Question 13

non-odontogenic pain

Answer 13

no apparent etiological factors associated with odontogenic pain
non-responsive to dental treatment
pain not relieved by local anaesthesia
usually bilateral and associated with headaches
increased pain associated with palpation of trigger points or muscles, emotional stress, physical exercises and head position

Question 14

allodynia

Answer 14

pain caused by a stimulus that does not normally cause pain

Question 15

analgesia

Answer 15

absence of pain in repose to stimulation that would normally be painful

Question 16

anaesthesia

Answer 16

absence of all sensation

Question 17

dysesthesia

Answer 17

unpleasant abnormal sensation, whether spontaneous or evoked (includes parenthesis, but not vice versa)

Question 18

hyperalgesia

Answer 18

increased sensitivity to noxious stimulation

Question 19

hyperesthesia

Answer 19

increase sensitivity to all stimulation, excluding special senses (if the sensation is painful, the terms alloydonia and hyperalgesia may be appropriate)

Question 20

hypoalgesia

Answer 20

diminished sensitive to noxious stimulation

Question 21

hypoesthesia

Answer 21

diminished sensitivity to all stimulation, excluding the special senses (if the sensation is pain, the terms hypoalgesia and analgesia may be appropriate)

Question 22

neuralgia

Answer 22

pain in the distribution of a nerve or nerves

Question 23

neuropathy

Answer 23

disturbance of function or pathologic change in the nerve

Question 24

analgesics

Answer 24

non opioids - paracetamol/NSAIDS
opioid

Question 25

trigeminal neuralgia

Answer 25

prototypic neuropathic facial pain
tic douloureux
occurring most frequently in patients older than 50 years (incidence 8:100000; female to male ratio 1.6:1)
sharp electric shock like pain in the face or mouth
common cutaneous trigger zones - corner of the lips, cheek, Ala of the nose, lateral brow, intra-oral trigger zones

Question 26

clinical features of trigeminal neuralgia

Answer 26

severe paroxysmal pain
unilateral (96%); right>left
mild superficial stimulation provokes pain
V2 and V3 dermatomes most commonly affected
frequently pain free between attacks
no neurologic deficits
no dentoalveolar cause found
local anaesthesia of trigger zone temporarily arrests pains

Question 27

medical treatment of trigeminal neuralgia

Answer 27

carbamazepine
newer anticonvulsants (gabapentin)
antispastic baclofen

Question 28

surgical treatment

Answer 28

microvascular decompression
gamma knife radio surgery
percutaneous needle thermal rhizotomy
balloon compression of the root entry zone

Question 29

burning mouth syndrome

Answer 29

a burning or aching sensation, dry mouth and altered taste
all or part of the oral cavity
tongue most frequent site
commonly seen in postmenopausal woman
cause is unknown
defect in pain modulation theory
improve without treatment over a 2 year period, or anticonvulsants as treatment