Oral Dysaesthesia and TMD Flashcards
How does cognitive deduction influence oral disease?
It is difficult to decipher whether the symptoms are coming from dental tissues, somewhere else or if it is a cognitive issue.
The patient has no dental pathology which matches with their symptoms but their brain makes it so that the patient perceives this as pain.
What is Oral Dysaesthesia?
Abnormal sensory perception in absence of abnormal stimulus.
Where could the symptoms in oral dysaesthesia be coming from?
Neuropathic- abnormal sensory stimulus, nerves aren’t functioning properly.
Somatoform- perception is wrong, the signal coming from the tissues is wrong.
What symptoms may someone have if they have oral dysaesthesia?
All modes of oral sensation involved
- burning or nipping feeling
- Dysgeusia
- Paraesthetic feeling
- Dry mouth feeling
- Chronic back pain
Usually a deep, dull, burning sensation that does not waken the patient from being asleep.
Altered behaviour- anxiety, depression.
What are the pre-disposing factors for oral dysaesthesia?
Deficiency states- haematinics, zinc, B12.
Fungal and viral infections
Anxiety and stress
Recent bereavement
Gender- more women present to OM than men
What is burning mouth syndrome?
Chronic condition which presents as a burning, scalding or tingling sensation in the oral cavity.
What is the clinical presentation of burning mouth syndrome?
Burning, tingling, scalding or numbness feeling in the oral cavity- bilateral and fluctuate in intensity.
Poorly localised pain
Pain is worse during the day
Relieved with drinking and/or eating
Common site- tongue, hard palate, gingivae, lips.
Absence in abnormalities in mucosa, despite symptoms.
Can also present with dry mouth, altered taste.
Usually stressed, anxious, depressed.
What is burning mouth syndrome most likely to be associated with?
Haematinic deficiency.
If the lips and tongue tip/margin are involved, then it is most likely parafunction.
If involved in any other site- then it is paraesthesia.
Describe the pathogenesis of BMS?
Neuropathic- number of nerve fibres innervating taste buds are reduced. This means there is a reduction in input from the Chorda Tympani, therefore, trigeminal and glossopharyngeal nerves need to compensate. Causes changes in how sensory information is processed in the brain with regards to pain.
Endocrinological- reduction in progesterone metabolites during menopause can cause adrenal steroid deficiency, this can reduce neuroprotective effects leading to dry mouth- can cause dysaeathesia.
Psychosocial- Depression and anxiety.
What investigations might you want to do in a BMS patient?
FBC, haematinics.
HbA1c, thyroid function test.
Autoantibody screen.
Contact allergy test
Psychiatric investigation
Fungal culture
What are the management strategies for BMS?
As a GDP
- refer to OM.
- Give analgesia advice- benzydamine 0.15% mouthwash, avoid hot and spicy foods, suck on ice and drink plenty of cold water, referral to GMP for FBC and haematinic checks.
In OM
- Clonazepam oral rinse and can also be given systemically.
- Capsaicin cream (0.025%)
- lidocaine gel (2%)
- Could also use Gabapentin, Pregabalin.
Nortriptyline- tricyclic.
- CBT.
What is Dysgeusia?
Oral condition whereby patients feel a bad taste, bad smell in their mouth but nothing is detected by the practitioner and nothing found on examination.
If someone complains of a bad taste in their mouth/smell, what would you do?
Full history- pain, swellings, pus.
Examine the mouth- look for perio/dental infections.
Ask if a partner has noticed it.
GORD
ENT causes- chronic sinusitis
Dry socket
Ulcer bursting- salty
What is Touch Dysaesthesia?
Patient feels they have pins and needles, tingling but have normal sensation when you test the area.
If someone presented to you with pins and needles or tingling, what would you do?
Cranial nerve examination.
Poke the area with a sharp object- does the patient feel pain? If they do, then the area is not numb.
2-point discrimination test.
Contact GMP to request an MRI.
Must exclude local cause- infection, tumour.
