W12 - Dyasthesia / Atypical Facial Pain - Curtin

Question 1

Define dysaesthesia

Answer 1

descriptive term - NOT a clinical entity

an abnormal unpleasant sensation due to damage to peripheral nerves

Question 2

Difference betwen neurogenic, neuropathic and neurological

Answer 2

Neurogenic - arising from nerves

Neuropathic - pathlogy associated with nerves

Neurologic - associated with nerves

Question 3

What is a syndrome?

Answer 3

A group of symptoms that appear together that do not appear to be directly related to one another

Question 4

Common dental procedures that can cause iatrogenic neuropathies (3)

Answer 4

wisdom teeth removal

IAN block

Implant insertion

Question 5

How to prevent iatrogenic neuropathy to the IAN (2)

Answer 5

• Pre op assessment (PA, OPG, CBCT, CT)
• Operative technique

Question 6

What does it mean when there is darkening of root on md third molars on opg

Answer 6

risk indicator of superpositioning of the third molar root on the IAN canal

Question 7

Why doesnt CBCT reduce neurosensory disturbances after wizzy removal compared to OPG

Answer 7

Doesnt change what you need to do

• Allows you to risk stratify

Question 8

Features of LA associated neurosensory disturbances (3)

Answer 8

1. >90% of LA associated NSDs are assoc with IAN blocks
2. Majority of LA-assoc NSDs are assoc with 4% solutions
   
   1. Strong epidemiological association

Question 9

Features of IAN dysasthesia

Answer 9

Function Difficulties (eating, drinking, speaking)

Sensory issues (paraesthesia, allodynia, burning, tingles)

Question 10

Features of IAN dysasthesia

Answer 10

Function Difficulties (eating, drinking, speaking)

Sensory issues (paraesthesia, allodynia, burning, tingles)

Question 11

Features of IAN dysasthesia

Answer 11

Function Difficulties (eating, drinking, speaking)

Sensory issues (paraesthesia, allodynia, burning, tingles)

Question 12

Is formication a good thing for wizzy exo?

Answer 12

Yes - means nerve is intact

pt will say “bugs crawling on me”

Question 13

Describe the methods of evaluating patients with dysaesthesia (5)

Answer 13

1. Test area affected (correct dermatome)
2. Subjective funciton
3. Light touch
4. Sharp-blunt discrimination
5. 2-point discrimination

Question 14

What should be added for further description of dysathesia?

Answer 14

Dermatome affected and characteristics

Question 15

Pathophysiology of dysaesthesia in general terms

Answer 15

Due to abnormality in neuronal funciton- either peripherally or centrally,

• varies on the cause

Question 16

Causes of non iatrogenic dysaesthesia (5)

Answer 16

More common in the general population

• Diabetes
• Excessive alcohol
• Nutritional
• Drugs
• MS

Question 17

Why should you beware of pts with exicsion SCC on lip

Answer 17

Distal spread

Question 18

What does the extent of nerve injury depend on? (3)

Answer 18

Depends on type of injury

degree of injury

Neural anatomy

Question 19

What is wallerian degeneration

Answer 19

active process of retrograde degeneration of the distal end of an axon that is a result of a nerve lesion

Question 20

What is neurotenesis

Answer 20

Complete transection (cut) of a peripheral nerve

Most severe

Neuropraxia

Question 21

Neuropraxia (def)

Answer 21

Injury to peripheral nerves that causes burning, stinging and pain

• Heal on their own

Question 22

axonotmesis

Answer 22

More severe type of peripheral nerve injury and is usually cased by crush, stretch or percussion

Question 23

Dental procedures which are associated with dyasthesia (3)

Answer 23

Extraction

Endo

Apicectomy

Answer 24

Atypical facial pain can sleep at night

Question 25

Iatrogenic neuropathy associated with wizzy removal

Answer 25

IAN (0.5-8%) Lingual nerve (0.5-10%) Long buccal nerve

Question 26

Why is articaine 4% controversial with IAN blocks

Answer 26

Some studies report higher incidences of neuro sensory disturbances

Question 27

3 common neuralgias/neuropathies associated with dental procedures

Answer 27

* Atypical Facial Pain / PIFP (83%) * Trigeminal neuralgia * misc. Neurop

Question 28

Outline the pathophysiology of nerve injury

Answer 28

**Iatrogenic or non iatrogenic** Iatrogenic - ex ian block, implant Non iatrogenic - conditions ex metabolic disturbance, diabetes, ms causing: Stretching, damage to structure (axons, myelin sheath)

Question 29

Describe the course of management for patients with iatrogenic dysaesthesia

Answer 29

reverse action Medications supportive management * Ex. take implant out

Question 30

Outline an appropriate course of management for patients reporting atypical facial pain (2)

Answer 30

Rule out dental cause Look for other cause of headache Be conservative in treatment plan (dont take out teeth you dont have to)

Question 31

2 Types of Facial Pain + examples

Answer 31

1. Headaches 1. Temporal / tension 2. Myofascial pain headaches 2. Neuralgias 1. AFP 2. Trigeminal neuralgia 3. Post herpetic neuralgia

Question 32

What is AFP / PIFP (definition)

Answer 32

**Atypical Facial Pain** **Persistent Idiopathic Facial Pain** Persistent facial pain with varying presentations recuring **daily for \>2 hours/day for \>3 months with nil clinical pathology**

Question 33

AFP / PIFP features (5) (who, age, effect)

Answer 33

* Female (76%) * 40's * Not hormonal * Sleep is not disturbed * Pain free interval on waking