TMD 1 - Differential diagnosis of persistent orofacial pain

Question 1

What are the 4 main groups of where orofacial pain comes from?

Answer 1

Odontogentic
Musculoskeletal
Neurovascular - migrane
Neuropathic

Question 2

What are the 3 subtypes of neuropathic pain?

Answer 2

Trigeminal neuralgia
Burning mouth syndrome
Phantom tooth pain

Question 3

What are the 2 cranial nerves that should be tested when examining orofacial pain?

Answer 3

CN V and VII

Question 4

What is temporal (giant cell) arteritis and what presentations arise?

Answer 4

Systemic inflammatory vasculitis
Temporal headache with visual disturbances
Claudication while eating (Jaw tires)
Palpably tender/inflammed superficial temporal arteritis
Needs urgent systemic steroids (prednisolone)

Question 5

What are the presentations of a migraine?

Answer 5

Persistent throbbing headache up to 72hrs
Nausea, vomiting, photo/phonophobia
Decreased ability to function

Question 6

What is the treatment management of migranes?

Answer 6

Prophylactic: when have over half days in month - anti epileptics, CCBs, BP meds
Abortive: when feel coming on - triptans used

Question 7

What are the presentations of trigeminal neuralgia?

Answer 7

Females

Paroxysmal, stabbing, short-lived pain –> myelin sheath isn’t present

Question 8

What is the treatment for trigeminal neuralgia?

Answer 8

Carbamazepine

Question 9

What is the primary cause of Burning Mouth syndrome?

Answer 9

Small fibre neuropathy

Question 10

How is Burning Mouth syndrome managed?

Answer 10

Address cause first

Primary treatment: topical or systemic - tricyclic antidepressants, anxiolytics, anti convulsants