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D3 Oral Surgery Ex4 > TMD MFP Article (Scully) > Flashcards

TMD MFP Article (Scully) Flashcards

1
Q

Pain in the teeth, mouth, face or head usually has what cause?

A

Local cause, often sequelae of caries (odontogenic pain)

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2
Q

What is orofacial pain that has no obvious underlying organic pathology?

A

Medically unexplained symptoms (MUS) or atypical facial pain

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3
Q

What is the most important means of diagnosing orofacial pain?

A

The patient’s history

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4
Q

What are the key points to gather in the patient’s medical history?

A
  1. Location
  2. Character
  3. Duration
  4. Frequency or periodicity
  5. Precipitating / aggravating / relieving factors
  6. Associated features
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5
Q

What questions should you ask about the location of pain?

A

Local or diffuse

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6
Q

If the patient points with one finger to their area of orofacial pain, what is most likely the cause?

A

Dental cause or trigeminal neuralgia

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7
Q

What will be the most likely pain type if the patient indicates a diffuse location or radiating across the midline?

A

Atypical facial pain

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8
Q

What questions should be asked about the character of a pt’s pain?

A
  1. Sharp
  2. Dull
  3. Aching
  4. Throbbing
  5. Shooting
  6. Pain scale
  7. Any sleep disturbance
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9
Q

What must always be considered when asking a patient about the character of their pain?

A

It is subjective

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10
Q

Pain from exposed dentin will have what duration?

A

Transient (lasting only a few seconds)

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11
Q

What is the duration and character of trigeminal neuralgia?

A

Lancating pain lasting up to 5 seconds

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12
Q

What is the duration of migrainous neuralgia?

A

30-45 minutes

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13
Q

What is the general duration of atypical facial pain?

A

Persistent

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14
Q

What can aide In determing the frequency and duration of orofacial pain?

A

Pain diary

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15
Q

What is the likely cause of a patient’s orofacial pain if their pain diary shows they have pain that is more severe on waking ?

A

Nocturnal parafunction such as clenching or grinding

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16
Q

The pain of sinusitis is aggravated by what?

A

Lying down

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17
Q

What is the term for when a patient has a sleep disturbance by pain, usually occurring around 2 a.m.?

A

Periodic migrainous neuralgia

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18
Q

What are things to ask for precipitating, aggravating, relieving factors?

A
  1. Temperature
  2. Biting
  3. Posture
  4. Analgesics
  5. Alcohol
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19
Q

Heat will aggravate what pain type?

A

Dental

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20
Q

Touching a trigger zone that causes pain is of what origin?

A

Trigeminal neuralgia

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21
Q

What pain can be worsened by stress?

A

Atypical facial pain

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22
Q

Migranous neuralgia can be precipitated by what?

A

Alcohol

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23
Q

An associated feature of pain such as swollen face would be of what cause?

A

Dental abscess

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24
Q

An associated feature of pain such as nausea or vomiting be of what cause?

A

Migraine

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25
Q

Nasal stuffiness or lacrimation can be associated with what?

A

Migrainous neuralgia

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26
Q

What is an adjunct to the history and general examination that can aide in properly differentiating between orofacial pain or an organic disease?

A

Head and neck imaging (CT or MRI)

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27
Q

What is the location of pain from oral mucosa lesions?

A

Localized or diffuse

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28
Q

A mucosal break, either an erosion or an ulcer will have what location of pain?

A

Localized

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29
Q

What is a partial thickness loss of epithelium?

A

Ulcer

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30
Q

Diffuse mucosal pain will usually be described as what?

A

Soreness or burning

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31
Q

Mucosal pain can be aggravated by what?

A
  1. Sour
  2. Acidic
  3. Spicy
  4. Salty
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32
Q

Will mucosal pain be tender to the touch?

A

Yes

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33
Q

What are things that may cause pain from the jaws?

A
  1. Infection
  2. Direct trauma
  3. Malignancies
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34
Q

What can rarely cause pain from the jaws?

A

Paget’s disease

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35
Q

If there is no associated infection, will retained root tips, impacted teeth, and lesions such as cysts be painful?

A

No, usually painless

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36
Q

What tumors of the jaw usually produce deep, boring pain, sometimes associated with paraesthesia or anesthesia?

A

Malignant tumors

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37
Q

Will odontogenic and other benign tumors of the bone produce pain?

A

No

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38
Q

Pain from salivary gland disorder would have what characteristic?

A
  1. Localized to affected gland
  2. Severe
  3. Intensified by increased salivation
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39
Q

What is a common orofacial pain syndrome characterized by pain, clicking and jaw locking or limitation of jaw opening ?

A

Temporomandibular pain - dysfunction syndrome

40
Q

Temporomandibular pain-dysfunction syndrome predominantly affects what demographic?

A

Young women

41
Q

What is the character of TMJ disease pain?

A
  1. Dull
  2. Poorly localized
  3. Radiates widely
  4. Intensified by mandibular movement
  5. Trismus due to muscles of mastication spasm
42
Q

When clinically examining for TMJ disease, if the joint appears to be warm or swollen, what is a differential diagnosis?

A

True arthritis

43
Q

What is the main management for TMJ pain dysfunction?

A
  1. Reassurance

2. Conservative measures

44
Q

What is the reassurance to the patient about their TMJ pain dysfunction?

A
  1. It is common

2. Most recover spontaneously / it is self-limiting

45
Q

What are 4 conservative measures to treat TMJ pain dysfunction?

A
  1. Rest with soft diet and limited movement
  2. NSAIDs (e.g. 400 mg ibuprofen 3/day)
  3. Occlusal splint
  4. Local physiotherapy
46
Q

What is the answer if a patient asks what is causing the TMJ pain dysfunction?

A

Can be related to stress, joint damage, or habits of the teeth and joint (e.g. grinding)

47
Q

In which position should a patient with TMJ pain dysfunction sleep?

A

On their side

48
Q

What musical instrument is contraindicated for a TMJ pain dysfunction patient?

A

Wind instruments

49
Q

How long should a cold pack be placed on a TMJ pain dysfunction pt if they can confirm it is due to a joint injury?

A

10 mins every 3 hrs for 72 hrs after injury

50
Q

What should be placed on a TMJ pain dysfunction pt if there is no history of trauma/injury to the joint?

A

Hot compresses for 20 mins, every 3 hrs

51
Q

Sensory innervations of th mouth, face, and scalp depend on what nerve?

A

CNV Trigeminal nerve

52
Q

What is an example of a demyelinating disease that can cause trigeminal nerve damage resulting in neurological caused orofacial pain?

A

Multiple sclerosis

53
Q

What is an uncommon nerve disorder that causes episodes of unilateral intense, stabbing, electric shock like pain in areas of the face where the trigeminal nerve distributes: lips, eyes, nose, scalp, forehead, upper jaw, lower jaw?

A

Idiopathic trigeminal neuralgia (ITN)

54
Q

What age group commonly affected by ITN?

A

50-70 years

55
Q

What is the theory of the etiology of ITN?

A

Cerebral blood vessels become atherosclerotic with age, compressing trigeminal n. root in the posterior cranial fossa causing neuronal discharge

56
Q

What is the duration of pain for ITN?

A

A few seconds to less than 2 minutes

57
Q

What time of day do ITN attacks occur?

A

Morning

58
Q

Will ITN cause sleep disturbance?

A

No

59
Q

What are the 5 characteristics, of which a patient must have 4, to be diagnosed with ITN?

A
  1. Pain along one or more of CN V distribution
  2. Sudden intense, sharp, superficial, stabbing or burning pains
  3. Severe pain caused by a trigger area or a certain activity, e.g. shaving or eating
  4. Patient asymptomatic between paroxysms.
  5. May have a dull ache
60
Q

What must be done before the Idiopathic Trigeminal Neuralgia can be definitively diagnosed?

A
  1. Assess all cranial nerves
  2. Imaging (MRI) to exclude space-occupying or demyelinating disease
  3. Blood tests to exclude infections or systemic vasculitided
61
Q

Will ITN show a spontaneous remission?

A

No, but can go away for months or years

62
Q

What is the main drug used for the treatment of ITN?

A

Anticonvulsant Carbamazepine

63
Q

What are the problems with prescribing Carbamazepine for ITN?

A

It can cause Ataxia, high blood pressure, impair liver function, decrease red and white cell counts by suppressing bone marrow

64
Q

What type of pain affects the throat and ear, and is typically triggered by swallowing or coughing?

A

Glossopharyngeal neuralgia

65
Q

What is a virus whose recurrence is preceded by neuralgia along with a unilateral rash and ulceration, and that can have neuralgia post-recurrence?

A

Herpes Zoster

66
Q

What is the character of post-herpetic neuralgia?

A

Burning pain vs lancing pain of trigeminal neuralgia

67
Q

What is the term for headaches caused by anxiety or stress induced muscle tension that is common in young adults?

A

Psychogenic / tension headaches

68
Q

What is the area of psychogenic / tension headache pain?

A

Frontal, occipital, or temporal

69
Q

What is the character of psychogenic / tension headache pain?

A
  1. Constant ache

2. Bandlike

70
Q

When is psychogenic / tension headache pain at its worst?

A

Evening

71
Q

Psychogenic / tension headaches usually abate with what?

A

Rest

72
Q

What are treatments for psychogenic / tension headaches?

A
  1. Reassurance
  2. Massage
  3. Warmth
  4. NSAIDs
  5. Benzodiazepines
73
Q

What is the term for constant chronic orofacial discomfort or pain, defined by the International Headache Society as facila pain not fulfilling other criteria. (diagnosed by exclusion)?

A

Atypical facial pain

74
Q

What is the character of Atypical facial pain?

A

Dull, boring, or burning, poorly localized

75
Q

What is the demographic of those presenting with atypical facial pain?

A
  1. Middle-aged
  2. 70% women
  3. Under stress (bereavement, worry)
76
Q

Will atypical facial pain cross the midline?

A

Yes

77
Q

Will atypical facial pain normally wake the patient from sleep?

A

No

78
Q

How is an atypical facial pain patient managed?

A
  1. Avoid surgeries or drugs
  2. Address underlying causes
  3. Consider antidepressants
79
Q

What is a possible diagnosis for a patient complaining of a burning mouth, with no identifiable cause,e.g. pt does not have Candidiasis, or has not just eaten a Jalapeño?

A

Burning Mouth Syndrome

80
Q

What is the demographic of a patient complaining of burning mouth syndrome?

A
  1. Middle-aged

2. Female

81
Q

What are things to rule out before diagnosing as Burning Mouth Syndrome?

A
  1. Erythema migrans
  2. Lichen planus
  3. Xerostomia
  4. Candidiosis
  5. Glossistis associated with haematinic deficiency (vitamins)
  6. Diabetes
82
Q

What is the character of Burning Mouth Syndrome pain?

A
  1. Chronic
  2. Bilateral
  3. Relieved by eating or drinking
83
Q

What is the term for pain and hypersensitive teeth int he absence of detectable pathology?

A

Atypical odontalgia

84
Q

Will atypical odontalgia be relieved with dental intervention?

A

No. Will be aggravated.

85
Q

Migraine, Migrainous neuralgia, Giant Cell arteritis are all examples orofacial pain caused by what?

A

Vascular dilation

86
Q

Which is more likely to cause orofacial pain: migraine or migrainous neuralgia?

A

Migrainous neuralgia

87
Q

What occurs in middle-aged males, has unilateral pain, occurs in attacks localized around the eye and will awaken the patient at the same time each night or in the early hours of the morning?

A

Migrainous neualgia

88
Q

What is the lay term for migrainous neuralgia?

A

Alarm clock headache

89
Q

What is a febrile disease where giant cells appear in arteries and cause a deranged internal elastic lamina causing an intense, deep, throbbing headache?

A

Cranial arteritis / giant cell arteritis

90
Q

Cranial Arteritis / Giant Cell Arteritis is made worse when a patient does what?

A

Lies down

91
Q

What is the artery commonly causing cranial arteritis / giant cell arteritis?

A

Superficial Temporal Artery

92
Q

What lab value would indicate cranial arteritis / giant cell arteritis?

A

Increased erythrocyte sedimentation rate

93
Q

What is the systemic treatment for Cranial Arteritis / Giant Cell Arteritis?

A

Corticosteroid (prednisone)

94
Q

Where would referred pain in a patient with angina present, especially if they exercise in the cold?

A

In the mandible

95
Q

What is the differential diagnosis for a patient with pain on chewing or turning the head caused by a calcified elongated stylohyoid process?

A

Eagle’s Syndrome

D3 Oral Surgery Ex4 (5 decks)

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