Non-Dental Facial Pain Flashcards
(42 cards)
What are the 6 classifications of orofacial pain?
- intra oral
- extra oral
- musculoskeletal
- neuropathic
- neurovascular
- psychological
What is an example of episodic neuropathic pain?
trigeminal neuralgia
What are 3 examples of continuous neuropathic pain?
- trigeminal neuropathy
- atypical odontalgia
- post-herpetic neuralgia
Which neurovascular pain condition would need an emergency referral?
temporal arteritis
What are 4 examples of facial pain red flags?
- bilateral facial pain described as toothache
- toothache with absence of dental pathology
- pain radiating to forehead, temple, cervical regions
- toothache with hearing changes, vertigo, tinnitus, facial weakness, altered facial sensation
What are the 7 main components of history taking when assessing non dental facial pain?
- principle complaint
- presenting illness
- past medical history
- past dental history
- habits: smoking, alcohol, drugs
- psychosocial history: stress, depression, anxiety
- consider all symptoms
What are the 4 most common causes of facial pain?
- oral ulceration
- sinus pain (maxillary, frontal, ethmoid)
- TMJ
- idiopathic trigeminal neuralgia
How is the TMJ examined?
- assess joint click/crepitus
- examine muscles of mastication esp. temporalis, masseter, pterygoids difficult to palpate
- range of opening and lateral movement
- deviation/deflection on opening
What conservative treatment options are there for a patient with TMJ?
- rest and soft diet
- NSAIDs
- physio and exercises
- heat pack if joint/muscle is uninjured
- reduce stress
- acupuncture
What are examples of splints that can be given to patients with TMJ and conservative treatment has not worked?
- emergency splint (de-programming Lucia jig)
- soft splint
- hard acrylic splint
- local occlusal interference splint (LOIS)
What medication can be used for TMJ that has not been responsive to other treatments?
diazepam
What is the surgery used to help with TMJ if other treatment has not worked?
arthroscopy (is the disc damaged and needing surgery? manipulation under GA)
The symptoms of which condition is the following?
- pain over upper cheek and teeth, may be bilateral
- worse when being forward
- history of upper respiratory tract infection (cold)
sinusitis
Signs of which condition are the following?
- maxillary teeth TTP
- may be nasal discharge
- tenderness, erythema over maxilla
sinusitis
What special investigations can be done to assess potential sinusitis?
- bitewing and/or PA to exclude dental cause
- radiograph may show fluid level in maxillary antrum, OPG (not justified for diagnosis unless dental involvement in suspected)
What are the treatment options for sinusitis?
- decongestants
- steam inhalations
- analgesics
- antibiotics last resort
What are the 2 types of trigeminal neuralgia?
- classic/idiopathic trigeminal neuralgia
- symptomatic/secondary trigeminal neuralgia
Which type of neuralgia would present with pain - ear, base of tongue, tonsillar regions?
glossopharyngeal neuralgia
Which type of neuralgia would present with pain - deep in ear canal?
nervus intermedius neuralgia
Which type of neuralgia would present with pain - distribution of greater and lesser occipital nerve?
occipital neuralgia
Which type of neuralgia would present with pain - post herpes zoster - often ophthalmic branch?
post herpetic neuralgia
Which medication is the following?
- drug of choice for trigeminal neuralgia
- anti-epileptic drug
- interactions common eg. Warfarin
- side effects: drowsiness, nausea, folic acid deficiency, megaloblastic anaemia
carbamazepine
Which type of trigeminal neuralgia is the following?
- predominantly forehead or orbit
- may be bilateral
- facial sensory or motor impairment
- red flag: tumours, aneurysm, MI, MS
secondary trigeminal neuralgia
What are 4 things that should be done for a patient presenting with trigeminal neuralgia?
- exclude dental causes of pain
- advisable to consult GP first
- diagnostic carbamazepine and review
- arrange prompt referral to specialist
