Orofascial Pain, Textook Flashcards
Diagnosis of orofacial pain?
Dental cause?
- caries, trauma, perio or cracked tooth
No
Lanciating pain?
- TN
No
Atypical facial pain
BMS
Referred pain
TMD
Postherpetic pain
How ask about pain?
Location
- one finger often dental cause / TN
- Atypical pain is much more diffuse and can cross midline
Character
- ask about severity
- McGill pain index
Duration
Frequency and periodoicity
Aggregating factors
Associated factors (Socrates for last two basically)
Cause local mucosal pain?
Most likely break in epithelium
- ulcer
- erosion
Diffuse mucosal pain?
Infection
Systemic underlying state
- lichen planus
Malignant tumour pain?
Deep boring pain
- associated with parasthesia or anaesthesia
- lip numbness / tingling etc may herald tumour in jaw bone
Salivary gland pain?
Mainly duct obstruction, infection or tumour
- localised to gland
- can be severe
- can be increased with rise in salivary flow at meals
- trismus / swollen gland
Paranasal sinus pain / nasopharynx pain?
Nasal discharge
Nasal obstruction
Cheek swelling
Lip tingling
Sinusitis
Diagnosis of TMD?
Clinical
- dull and poorly localised pain
- radiate widely
- usually intensified with movement of manidble
- can be associated with trismus
- limited jaw movement
- clicking in joint
- tender MOM
TMD managements?
Rest yourself and jaw
- be mindful of when clenching
Soft diet, avoid hard chewy foods
- dont chew gum
- eat small bites
Limit wide mouth opening
Support jaw when yawning
Hot and cold packs
Jaw exercises
- opening and closing and avoiding lateral movements, slowly
Analgesia
- ibuprofen
Characteristics of TN?
Paroxysmal attacks
- lanciating stabbing pain, electrical shock
- distributed along trigeminal nerve branch
- severe pain
- trigger areas / spots
- usually asymptomatic between attacks
What is herpetic and post herpetic neuralgia?
TN like pain along branch of nerve herpes virus is dormant in
- often precedes and accompanied by neuralgia
- can last after vesicles and rash have gone, but more burning sensation vs lancinating
PIFP?
Dull boring or burning pain
- poorly localised
- lack of objective signs
- no clear explanation
Middle aged +
Females >
Give some possible causes of a burning sensation in mouth
Candida
Lichen planus
Geographic tongue
Denture issues
Parafunction
Depression and anxiety
Haematinic deficiency
Dry mouth
Diabetes
Drugs
- ACE inhibitors
Likely history from pt with BMS?
Chronic
Usually bilateral
Relieved by eating and drinking is often
Alcohol can reduce symptoms
Often also other psychogenic related complains
- dry mouth
- bad taste
- headaches
- chronic back pain
- IBS
Tests for someone with BMS?
FBC
- anaemia etc
Diabetes screen
Thyroid tests
Saliva tests
Candida swab
