non odontogenic pain Flashcards
(18 cards)
How is pain categorised?
- Nociceptive - due to damage or threatened damage in non neural tissue due to activation of nociceptors
- Neuropathic - lesion or disease of the somatosensory nervous system ( TN)
- Nociplastic pain - increased sensitivity from the altered function of pain - Related sensory pathways in the periphery and central nervous system (CNS)
What are the three presentations of TN?
- Classical
- Secondary
- Idiopathic
ALL HAVE THE SAME PRESENTATION
How might a patient describe TN pain?
- Stabbing
- Electric shock
- Scary
- 10/10
- Severe
- Memorable first episode
SOCRATES for trigeminal neuralgia?
Site - unilateral
onset - spontaneous and sometimes triggered
character - sharp electric like shock pain
radiation
associated features - depressoin, distress, suicidal
time - Random , short lived up to 2 mins
exacerbating factors - Cold wind, brushing, shaving, washing face
sleep - May or may not wake from sleep
What are red flag features to ask about for someone presenting with TN?
- Sensory motor defects
- Deafness
- Loss of balance
- Optic neuritis
- History of craniofacial malignancy
- Bilateral TN
- Systemic symptoms
- less than 30 yrs old
What is the management of TN in general dental practice?
- Obtain accurate diagnosis , exclude dental/TMD pathology
- Consider commencing Carbamazepine , liaise with GP
- LA of pt is in extreme pain
- Urgent referral to OM for definitive advice
What blood tests to carry out before/during prescribing carbamazepine?
- FBC
- U&E
- LFT
arrange with GP
How is Trigeminal neuralgia managed in secondary care?
- MRI scan to identify
^ Space occupying lesion
^ MS
^ Neurovascular conflict
if MRI contraindicated then CT - Medications
- Neurosurgery
What is oral dysaesthesia?
idiopathic chronic condition characterised by persistent alteration to oral sensation perceived to be abnormal or unpleasant in the absence of an indentifiable local or systemic cause
What might contribute the aetiology of oral dysaesthesia?
- Neurological
- Biological
- Psychological
Causes are poorly understood
How does pain in oral dysaesthesia described as?
- Prickling
- Burning
- Numb
- Tingling
- Shooting sensation
What is the SOCRATES for oral dysaesthesia?
S - anterior of tongue , palate , lips and labial mucosa
O - random
C - burning/numb / shooting
R - no spread of pain
A - dry mouth, altered taste
T - worse at night , constant
E - worry, isolation , relieved by eating , drinking, socialising
S - does not wake pt at night
What are some red flags to ask about regarding oral dysaesthesia?
- Permanent numbness
- Unilateral symptoms
- Dysphagia
- Odynophagia
- Weight loss
- Loss of balance / hearing change
- Unexplained motor or other sensory changes
URGENT REFERRAL INDICATED IN THESE INSTANCES
What investigations would you carry out for oral dysaesthesia?
- FBC
- Haematinics
- TFT
- HbA1c - to exclude diabetes
What is the management of oral dysaesthesia in primary care?
- History
- Look for other diagnosis
- Show empathy
- Recognise that the pain is real and tell them this
- Let them know they are not alone in this
- Provide the BISOM leaflet on BMD as an unconfirmed diagnosis
What is the management of oral dysaesthesia in secondary carE?
- Psychological therapy - CBT counselling
- Improving sleep - caffeine intake , alcohol, sleep , discussion with GP
- Holistic - Exercise, Explanation of chronic pain , reflect back to what is impacting their life the most
What are some topical treatments for oral dysaesthesia?
- Saliva substitutes
- Difflam mouthwash
- Clonazepam mouthwash - Specialist only
What are some systemic special care treatments for oral dysaesthesia?
- Tricyclic antridepressants
- Venlafaxine
- Anticonvulsant - gabapentin or pregabalin
