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Endo II > Odontogenic and Non-odontogenic pain > Flashcards

Odontogenic and Non-odontogenic pain Flashcards

(41 cards)

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1
Q

What is the definition for site of pain?

A

Where people perceivetheir pain

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2
Q

What is the definition for source of pain?

A

The location of a pathophysiologic process giving rise to the pain (may or may not be in the same region)

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3
Q

What is the definition for referred pain?

A

The attribution of pain to an anatomic region that is different from the location of the etiologic process

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4
Q

What is pain?

A

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

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5
Q

What is nociceptive pain?

A

Pain arising from activation of nociceptors

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6
Q

What is neuropathic pain?

A

Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system

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7
Q

What are the two types of pain that can occur in patients?

A

Tooth Pain: Odontogenic
Non-Tooth Pain: Non-Odontogenic

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8
Q

What is tooth pain/odontogenic?

A
  • Originates from tooth or surrounding periodontal structures
  • Originates from a dental pathology
  • Has a typical dental history profile of endo or perio pathology
  • Direct testing and manipulation usually reproduces symptoms
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9
Q

What must you rule out first before considering other causes of pain?

A

Tooth Pain: Pulpal/Periapical

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10
Q

How is tooth pain percieved in pulpal/periapical areas?

A
  • Pulpal Nociceptors (A-beta, A-delta, and C fibers)
  • Periapical, Osseous, Sinus Nociceptors
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11
Q

How is tooth pain (pulpal/periapical) mitigated?

A

Mitigated by treatment and medication
- Pulpotomy, pulpectomy
- I & D to drain abscess
- Analgesics for Pain
- Antibiotics for infection with swelling/fever

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12
Q

What are important fibers for teeth pain?

A
  • A-delta (sharp, fast, localized, first pain in a tooth)
  • C fibers (dull, aching, diffuse, second pain, spontaneous pain)
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13
Q

What is referred pain for tooth pain (pulpal/periapcial)?

A

due to convergence of multiple primary afferent nerve fibers into single second order projection fiber in the medullary horn

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14
Q

What is hypersensitivity?

A

due to increase in local neural activity or due to increased stimulation (reduced threshold) of secondary nerve fibers centrally due to a barrage of primary fiber stimulation (Central Sensitization)

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15
Q

What is allodynia?

A

pain to what would normally be a non-painful stimulus

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16
Q

What is an example of referred pain for tooth pain?

A

Maxillary Molar Pain Referred to Mandibular Tooth and Jaw

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17
Q

What is an example of hypersensitivity for tooth pain?

Study These Flashcards
A
  • Exaggerated Cold Response
  • Other Teeth also very Sensitive to Percussion
  • Pulpal Testing
18
Q

What is an example of allodynia for tooth pain?

Study These Flashcards
A
  • Severe Percussion Sensitivity
  • Adjacent Tooth Percussion Sensitivity
  • Sun Burn Sensitivity
19
Q

What can be done for abscessed teeth in pain?

Study These Flashcards
A

Pulpectomy, Ca(OH)2, I & D

20
Q

What analgesics can be given for teeth in pain?

Study These Flashcards
A

Ibuprofen 400mg, Acetaminophen 500mg
Every Six Hours

21
Q

____% OF PAIN “resolved with endo” if properly diagnosed

22
Q

______% persistent pain when treated with endo

Study These Flashcards
A

10%
- 5% untreated canals, fractures, persistent infection
- 5% neuropáthic, neurovascular… etc

23
Q

A nonodontogenic toothache has a source of pain that is…

Study These Flashcards
A

not the tooth the patient has indicated

24
Q

What is used to rule out tooth pain and instead find out it is nonodontogenic toothache?

Study These Flashcards
A
  • chief complaint
  • proper radiographs to rule-out odontogenic related etiologies
25
Apical fenestration may occur in ___% of cases and may be considered an anatomic predisposing factor for persistent pain after root canal treatment
9%
26
Why is it important to be able to rule out odontogenic pain?
There is a risk that endodontic treatment may be initiated in patients that do not have pulp or periapical pathosis
27
In a six-month period... - _____% of Americans experienced at least one of five types of facial pain - ____% was toothache
22% 12.2%
28
What is peripheral sensitization?
Increased responsiveness and reduced thresholds of nociceptors to stimulation of their receptive fields
29
What is central sensitization?
Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input
30
What is heterotopic pain?
- Any pain that is felt in an area other than its true source is heterotopic pain - Cannot be provoked by stimulation of the area where the pain is felt - Cannot be arrested unless the primary source of pain is anesthetized
31
What are the types of non-odontogenic pain conditions?
- **TMD, TMJ, muscle pain** - Neuropathic (Neuritis, Neuroma, Neuralgia) - Referred pain (sinusitis, cancer) - Neurovascular
32
What is the most frequent non-odontogenic diagnosis?
temporomandibular disorders
33
Myofascial pain (MFP), also knowns as myofascial paindysfunction (MPD), emanates from...
small foci of hyperexcitable muscle tissue
34
What are the features of myofascial pain (MFP)?
- Clinically these areas feel like taut bands or knots and are termed trigger points - The pain is described as a diffuse, constant, dull, aching sensation; this may lead the clinician to a misdiagnosis of pulpal pain - Another potentially misleading characteristic of masticatory muscle pain is that patients may report pain when chewing
35
How do you treat myofascial pain (MFP)?
Muscle relaxants (cyclobenzaprine/flexeril) every 24 hrs. night!
36
What are the examples of neuralgic/neuropathic pain?
- Post Herpetic Nerve Damage - Post Surgical Nerve Damage - Post Traumatic Event Nerve Damage --- Example: Trigeminal Neuralga
37
What are the neuropathic red flags?
- No apparent etiology - Migration of pain, no improvement - Does not change with time - Atypical (Burning, electric shock) - Can’t be reproduced or provoked - Local anesthesia and analgesics ineffective - Doesn’t respond to dental treatment
38
What is persistent post-procedural pain (PPSP)?
* Consequence of surgery * Lasts at least 2 months * Noother explanation for pain * Not a continuation of preexisting chronic pain condition for which the surgery was performed
39
What could be causing referred pain?
- sinusitis - cancer
40
To diagnose a sinusitis (ODS)...
otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings
41
What are the options for neurovascular pain?
Migraine Carotid Arteritis Cluster Headache Paroxysmal Hemicrania

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