8 - Orofacial Pain

Question 1

the most common cause of pain in the orofacial region is what in origin

Answer 1

inflammatory disease of pulpal origin

Question 2

before treating a patient in pain, what is imperative

Answer 2

correct diagnosis is imperative

Question 3

what is this:

gating mechanism in the substantia gelatinosa of the spinal cord and brainstem on which both peripheral nerve fibers and descending central influences exert their effect in pain experience

Answer 3

gate control theory

Question 4

principles of gate control theory

Answer 4

1. descending control mechanisms from higher central nervous centers
2. cognitive, motivational and affective processes
3. degree of activity in large-diameter and small diameter nerve fibers
4. large diameter fibers are activated by non-noxious stimuli and close the gate
5. small diameter fibers are activated by noxious stimuli and “open the gate”

Question 5

Answer 5

Question 6

Large diameter fibers are activated by
___ and ___.

Answer 6

non-noxious stimuli and “close the gate”

Question 7

Small diameter fibers are activated by
___ and ___.

Answer 7

noxious stimuli and “open the gate”

Question 8

what is pain perceived to originate from a site with no damage

Answer 8

referred pain

Question 9

what theory occurs when afferent nerves converge on same second order neuron

Answer 9

referred pain convergence theory

Question 10

what are possible sources of referred pain

Answer 10

muscles, ear, sinuses, heart, and other teeth

Question 11

can muscles of mastication refer pain to teeth

Answer 11

yes

Question 12

where do you palpate muscles of mastication

Answer 12

muscle insertions

Question 13

what provides myofascial pain dysfunction syndrome?

Answer 13

TMD/muscles of mastication -> patients with these condition describe toothache as one of their symptoms

Question 14

what is referred pain from respiratory mucosa to teeth

Answer 14

sinus pain

Question 15

where does sinus pain deliver pain

Answer 15

posterior maxillary teeth

Question 16

what dose sinus pain feel like

Answer 16

tender to mastication and hypersensitive to cold, tenderness to pressure on cheeks, pain worsened by lowering head and jumping on heels

Question 17

people with sinus pain have a history of what

Answer 17

history of respiratory infections and allergies

Question 18

what is referred pain from angina pectoris or myocardial infarction

Answer 18

cardiac origin

Question 19

which arch can perceive pain of cardiac origin?

Answer 19

EITHER arch! but left mandible is most common

Question 20

occasionally, cardiac pain is only felt where

Answer 20

face and jaws

Question 21

T/F: toothache is incapable of being referred to other teeth

Answer 21

FALSE! it is capable. there are many tooth pain referral patterns

Question 22

what commonly refers pain to the ear

Answer 22

mandibular molars

Question 23

as inflammatory mediators spread, can pain diffuse thru a wider area?

Answer 23

YES!

Question 24

what are types of spreading pain

Answer 24

1. primary spreading pain
2. secondary spreading pain (muscle)
3. allodynia

Question 25

what is a pain due to a stimulus that does not normally provoke pain?

Answer 25

allodynia e.g., light feather touch (that should only produce light sensation) causes pain

Question 26

what are other sources of orofacial pain

Answer 26

1. psychogenic pain 2. neuritis 3. neuralgia 4. atypical orofacial pain

Question 27

what pain: - no identifiable origin - multiple (especially bilateral pain sites) - pain does not respond to therapy (especially analgesics) - unusual, inconsistent, illogical non-anatomic pain patters

Answer 27

psychogenic pain

Question 28

what pain: - Pain has strong emotional and affective components - Focus is on social and emotional problems - Activity in higher centers may originate pain - Mouth and face have important emotional significance

Answer 28

psychogenic pain

Question 29

what is a tentative LAST RESORT diagnosis and indicates referral?

Answer 29

psychogenic pain

Question 30

what pain: - Pain is severe - Trigger zone - Usually limited to distribution of one branch of the trigeminal nerve - Can mimic tooth pain - Symptoms cannot be initiated by stimulating dental structures

Answer 30

trigeminal neuralgia

Question 31

are headaches capable of referring pain to teeth and viceversa?

Answer 31

YES

Question 32

types of headaches

Answer 32

1. vascular headaches (migraine) 2. cluster headaches 3. tension headaches

Question 33

what questions to ask to diagnose pain

Answer 33

- is pain of dental origin? - which tooth is it?

Question 34

you should always do what when doing pain diagnosis

Answer 34

always reproduce patient symptoms

Question 35

what to do with difficult pain diagnosis

Answer 35

- provide symptomatic relief and observe patient - seek an expert opinion