Tutorial 5 Flashcards
what questions would you ask re-facial pain to exclude red flags
- systemic symptoms
- <30 y/o
- numbness, altered sensation [unilateral]
- swallowing changes
- vocal hoarseness
- unexplained weight loss
- jaw claudication + temporalis pain may indicate giant cell arthritis = medical emergency
22 y/o female presents with facial pain, both sides, comes and goes, 6/10
find it hard to open mouth fully
gets worse with stress
no joint noises
what is your diagnosis
myofascial pain = muscles, only 6/10, intermittent, no joint pain
bilateral suggests not TN
what guidelines would you use to diagnose pt with facial pain
RCS TMD
royal college surgeons
what conditions would you want to exclude as a GDP when pt presents with facial pain
odontogenic - infection, pericoronitis
obvious malignancies
radiographs if suspicious
sensibility tests
measure inter-incisal distance
what advice and tx would you offer to pt with myofascia pain
reassure, self-limiting, education
conservative - soft diet, avoid wide opening, support jaw when yawning, avoid sticky foods + nail biting, be mindful chelnching, place tongue behind UI to put in neutral position, avoid caffeine/soking, improve sleep, relaxation, de-stress
analgesia, heat/cold packs, massage
what therapeutic options may be offered to pt with myofascial pain
hypnotherapy, NSAIDs, jaw exercises, botox, CBT, physiotherapy, acupuncture
tricyclic antidepressants [amitriptyline]
65 y/o female presents with 2 year history of nipping sensation on tongue dorsum and dry mouth
she has anxiety, takes propanalol
symptoms improve when looking after grandchildren and eating
what is provisional diagnosis
what would you like to exclude
burning mouth syndrome
odontogenic, candida, olp, dm, pemphigus, geographic tongue
what blood investigations would you undertake in burning mouth syndrome + why
FBC, haematinic [ferritin, folate, B12], HbA1c
to exclude Dm, deficiencies, anaemia
low b12 associated with nerve deficiency
what red flags would you exclude in burning mouth syndrome
systemic
unilateral/bulateral
swelling
swallowing issues
hearing loss
cranial nerve defects
how would you explain burning mouth syndrome to pt
chronic condition which causes burning/uncomfortbale sensations
element of peripheral nerves sensing inappropriate signals as well as wrong percieving
what advice would you give to pt which may help with burning mouth syndrome symptoms
reassure, leaflet, not alone
distraction, education, exercise, sugar free sweets
what is first line therapeutic option for oral dysaesthesia in secondary care
tricyclic antidepressant
not a cure, takes 3 months to work
side effects [constipation, dizzy, dry mouth]
there are 3 types of trigeminal neuralgia
what are they and how do they differ
classical-
without apparent cause other than neuromuscular compression, artery pulses on nerve
secondary -
due to underlying disease e.g. MS, space occupying lesion
idiopathic -
uni/bilateral pain in distribution of 1+ branch of trigeminal nerve, indicative of neural damage but unknown cause
which division of CNV [trigeminal] is affected in TN
V2 + 3 mostly
mandibular branch
name common triggers for TN
mechanical stimuli - touch, shaving, makeup
oral/facial movement - talking, eating
stress, cold weather, temp change, breeze, smiling, washing face
what red flags would you want to exclude in TN
altered sensation anywhere else
sensory/motor defects
loss of balance
systemic symptoms
<30
bilateral
deafness
first line therapeutic option for TN management in primary dental care?
what are side effects?
what monitoring needs to be done and how?
CARBAMAZEPINE
800-1200mg max 1600mg
dose split into 4x 200mg tabs
hyponaetremia - monitor sodium via FBC, U+E
what 2nd line therapeutic management for TN in secondary care
oxcarbazepine
lamotrigine
baclofen
pregablin
gabapentin
describe 3 surgical approaches used in TN management
microvascular decompression -
move nerve from vessel and adding pillow, low sensory risk to nerve but highest surgical risk
neuroablative procedure -
go through skin, balloon insertion to compress nerve, higher change of numbness but fewer surgical risks
stereotactic radiosurgery
what is persistent idiopathic dentoalveolar pain
chronic neuropathic pain localised to dentoalveolar region
absence of identifiable cause
