Facial Pain 3

Question 1

What is oral dysaesthesia?

Answer 1

• abnormal sensory perception in absence of abnormal stimulus
• burning/ nipping feeling
• dysgeusia
• paraesthesia feeling
• dry mouth feeling

Question 2

What is dysgeusia?

Answer 2

• foul, salty, rancid/ metallic taste sensation that persists in mouth
• bad taste, bas smell, halitosis
• ENT causes- chronic sinusitis
• perio/ dental infection
• GORD

Question 3

Predisposing factors of Oral Dysaesthesia?

Answer 3

Deficiency in
- haematinics
- zinc
- Vit B1 and B6

Fungal and viral infections

Anxiety and stress

Gender- might be because more women present to OM than men

Question 4

Burning Mouth Syndrome

Answer 4

• dysaesthesia most likely associated with haematinics deficiency
• SITE IS IMPORTANT
• lips, tongue tip/ margin - parafunction
• Multiple sites - dysaesthesia

Question 5

Touch Dysaesthesia

Answer 5

• pins and needles
• tingling sensation
• must exclude organic neurological disease
• must exclude local causes: infection/ tumour
• MRI essential- demyelination/ tumour

Question 6

Dry Mouth Dysaesthesia

Answer 6

• very common
• C/O debilitating dry mouth/ sjogrens
• eating okay
• wrose when waken at night
• usually associated with anxiety

Question 7

Management of Dysaesthesia

Answer 7

• explain the condition to the pt “pins and needles”
• assess degree of anxiety, ie: anxiolytic medication & clinical psychology

Question 8

Medication for Dysaesthesia

Answer 8

Anxiolytic based medication
- Nortriptyline
- Mirtazepine
- Vortioxetine

Neuropathic medication
- Pregabalin
- Gabapentin
- Clonazepam as topical

Question 9

Classifying pt for TMJ

Answer 9

1. Joint degeneration
   - pain on use & crepitus
   - rest pain
2. Internal derangement
   - Locking open/ close
3. no joint pathology

Question 10

Causes of TMJ

Answer 10

• occlusion
• grinding
• clenching
• stress

Question 11

Physical Signs in TMD

Answer 11

• clicking joint
• locking with reduction
• limitation of opening mouth
• tenderness of masticatory muscles
• tenderness of cervico-cranial muscles

Question 12

Examination findings

Answer 12

• focal muscle tenderness, ie: masticatory, trapezius, sternomastoid muscle
• tenderness over TMJ
• limitations of opening
• joint noises
• deviation when opening
• might be due to high dental occlusion upsetting TMJ

Question 13

Investigations for TMD

Answer 13

• usually none for functional disorders
• ultrasound scan-> if functional visualisation of disc movement is needed
• CBCT if bony problem suspected
• MRI- best image of disc
• Arthroscopy to directly visualise disc

Question 13

Management of TMD

Answer 13

• how to self- help
• soft diet and analgesia
• bite splint
• biochemical manipulation with Tricyclic (not SSRI)
• physiotherapy
• acupuncture

Question 14

Children with TMD

Answer 14

• tendency to anxiety neurosis
• if parents anxious, then child may be too
• reaction to abuse/ bully in school
• physical abuse