OEQs

Question 1

How many hours within a 24 hours period will you advise your patient that they. may wear their occlusal splint?

Answer 1

8-12 hours

Question 2

What is the function of occlusal splints?

Answer 2

1. decrease loading of the TMJ
2. Reduce trauma in masticatory muscles caused by bruxism
3. protect teeth from attrition

Question 3

Which type of splint is LEAST LIKELY to create occlusal changes?

Answer 3

Stabilization splint

Question 4

What are some complications associated with incorrect or excessive use of splints?

Answer 4

1. occlusal changes
2. speech difficulty
3. psychological dependence

Question 5

Which type of appliance is indicated in an 8 year old child experiencing jaw pain due to bruxism?

Answer 5

Soft splint

Question 6

Which painful disorders are treated with a stabilization splint?

Answer 6

1. myalgia/myofacial pain
2. capsulitis/synovitis
3. osteo/rheumatoid arthritis
4. anterior disc displacement with reduction
5. attrition prevention

Question 7

How frequently should you evaluate a stabilization splint in your patients with malocclusion due to arthritis of the TMJ?

Answer 7

Evaluate every 2-4 weeks for the first 3 months, and then every three months after that

Once stable, reassess every 6 months

(she also mentioned to see then 1 week after delivery to check in and for the patient to bring to their hygiene appointments)

Question 8

The goals of anterior repositioning splint:

Answer 8

1. Decrease loading of posterior attachment
2. decreases jaw catching
3. decrease severe TMJ pain

Question 9

The is NOT the goal of anterior repositioning splint?

Answer 9

To recapture the articular disc (we can’t guarantee this)

Question 10

Which of the following treatments for trigeminal neuralgia is a non-surgical treatment?

Question 11

Paroxysmal or constant pain, typically with sharp, stabbing, itching, or burning character in the distribution of a nerve:

Answer 11

Neuralgia

Question 12

Dull, continuous aching or burning pain in the oral cavity, or teeth or jaw, evolving eventually into trigeminal neuralgia

Answer 12

Pre-trigeminal neuralgia

Question 13

Sudden, usually unilateral, severe, brief, stabbing, or lancinating, recurrent episodes of pain in the distribution of one or more branches of the 5th cranial (trigeminal nerve)

Answer 13

Trigeminal Neuralgia

Question 14

Differential diagnosis for trigeminal neuralgia:

Answer 14

1. SUNCT
2. Cluster-tic syndrome
3. Giant Cell Arteritis
4. MULTIPLE SCLEROSIS
5. Other neuralgia

Question 15

When should MRI or MRA be considered in a trigeminal neuralgia case?

Answer 15

1. If patient is younger than 40
2. If patient is experiencing sensory loss
3. Patients with BL symptoms
4. Patients who do not respond to conservative therapy

Question 16

What medication might you prescribe for chronic neuropathic pain?

Answer 16

Carbamazepine 400-1200mg per day

Question 17

Surgical therapy for Trigeminal Neuralgia:

Answer 17

1. Microvascular decompression
2. Radiofrequency Rhizotomy
3. Glycerol Rhizolysis
4. Balloon Compression
5. Gamma Knife Radiosurgery (non-invasive)
6. Peripheral Neurectomy

Question 18

Destroys portion of the nervous system to block transmission of nociceptive information:

Answer 18

Gamma Knife Radiation (Neuroablative procedure)

Question 19

A complex series of electrochemical events that occurs between a site of active tissue damage and the perception of pain:

Answer 19

Nociception

Question 20

Your patient is experiencing sharp, electric shock-like pain in the maxillary left teeth and left face. You diagnose your patient with trigeminal neuralgia. What is the medication that is considered to be the “gold standard” prescribed to control this pain?

Answer 20

Tegretol (Another name for Carbamazepine)

Question 21

• Severe paroxysmal lanicinating pain that radiates to the throat, ear, teeth, and tongue
• Rare and unilateral
• Triggered by tonsillar movement (swallowing or coughing)
• Due to lesion in cranial nerve 9

Answer 21

Glossopharyngeal neuralgia

Question 22

Multiple sclerosis is a demyelinating disease that can present as toothache in or or more quadrants. The pain can be sharp, electric pain lasting for minutes. Which image would best help with your diagnosis?

Answer 22

MRI of the brain

Question 23

Which of the following conditions should be ruled out and treated before diagnosing your patient with burning mouth syndrome?

Answer 23

1. Xerostomia
2. Candidiasis
3. Iron and Vitamin B12 and B6 Deficiencies

Question 24

All of the following are diagnostic criteria for burning mouth syndrome:

Answer 24

1. Daily intraoral pain that persists for most of the daytime
2. The oral mucosa appears normal clinically
3. Primarily effects the anterior 2/3 of the tongue

(NOT affects males as common, mostly females in 4th and 5th decades due to estrogen decrease)

Question 25

Neuropathic pain is caused by which of the following?

Answer 25

1. Herpes Zoster Virus 2. Multiple Sclerosis 3. RCT and dental extractions

Question 26

Which of the following is FALSE regarding atypical odontalgia:

Answer 26

False- it commonly affects the maxillary anterior teeth

Question 27

What is true regarding atypical odontalgia:

Answer 27

1. More prevalent in post-menopausal females 2. Pain is present for hours during the day time 3. Light touch can induce or worsen the pain

Question 28

Elongation or ossification of the stylohyoid ligament:

Answer 28

Eagles syndrome

Question 29

What would a radiograph reveal in eagles syndrome?

Answer 29

elongated stylohyoid ligament

Question 30

Eagles syndrome is associated with:

Answer 30

1. elongated, calcified stylohyoid ligament (radiograph) 2. Neck pain induced by turning head 3. Ear pain (otalgia) NOT VERTIGO

Question 31

5-HT agonist drugs (Triptans) are considered to be which of the following categories of migraines meds?

Answer 31

Abortive medications

Question 32

Preventive migraine medication categories include:

Answer 32

1. Calcitonin Gene Related Peptide Antagonists (CGRP antagonists) 2. Calcium channel blockers 3. Anti-depressants (Triptans are abortive medications- gets rid of the headache once its already there, NOT preventive)

Question 33

Which of the following diagnostic criteria MUST BE present for a diagnosis of migraine headache:

Answer 33

1. Attack lasts 4-72 hours untreated or with failed treatment 2. Must have at least one of the following: - nausea - vomitting - photophobia - phonophobia 3. Must have at least two of the following: - unilateral - pulsating - moderate to severe pain - worsened by physical activity

Question 34

Migraine headaches are comorbid with which of the following medical conditions?

Answer 34

1. Stroke 2. Epilepsy 3. Depression 4. Anxiety Disorders

Question 35

Common food triggers for migraines include:

Answer 35

1. Chocolate 2. Alcohol (Esp red wine) 3. Caffeine 4. Aged Cheese (cheddar) 5. Citric fruits 6. MSG, Nitrates, Aspartate

Question 36

Migraines can cause facial pain and toothache due to activation of which nerve?

Answer 36

Trigeminal

Question 37

All of the following features are associated with migraine headaches except?

Answer 37

Except: Primarily affects males Migraines ARE associated with: 1. primarily affects post-menopausal women 2. Affects 1st degree relatives 3. Chromosome 19 associated with migraines

Question 38

Prophylactic migraine medications should be prescribed if all of the following criteria are met:

Answer 38

1. The patient has to take triptans for at least 3 days per week 2. Quality of life has been significantly affected 3. Disability causes the patient to miss work more than 7 days per month

Question 39

When a migraine headache pain begins to diminish, this phase is called:

Answer 39

Resolution

Question 40

List some examples of pathophysiology of migraines:

Answer 40

1. Activation of the Trigeminovascular system 2. TVS releases neuropeptides (inflammatory chemical mediators) 3. Serotonin (5HT) receptor gets activated 4. increased vasoconstricton * CGRP is also believed to play a major role in migraine pathogensis

Question 41

List some features for chronic paroxysmal hemicrania:

Answer 41

1. Severe pain is localized to temporal , ocular, maxillary, and frontal regions 2. Toothache may a symptom (rare) 3. Attacks are ALWAYS unilateral and occur multiple times per day 4. Female Predilection

Question 42

Tension Type Headache is associated with which of the following signs and symptoms?

Answer 42

1. Pressure or vice like pain 2. Bilateral pain location 3. Physical exercise improves the headahce (No vomitting or nausea or photophobia + phonophobia)

Question 43

List some features of cluster headaches:

Answer 43

1. Severe, unilateral/supraorbital and/or temporal pain 2. Headache attack frequency ranges up to 8 attacks per day 3. Duration 15-180 minutes 4. At last 1 autonomic feature present (lacrimation, eyelid edema, miosis) 5. Headaches attacks occur at the same time of day following one circadian pattern

Question 44

Trigeminal Automonic Cephaglias (TACs) include:

Answer 44

ALL TACS ARE UNILATERAL HEADACHES ACCOMPANIED BY AUTONOMIC FEATURES 1. Cluster headaches 2. Paroxysmal Hemicrania 3. Short-Lasting Unilateral Neuralgiaform headache attacks (SUNCT) 4. Hemicrania Continua 5. Probable bigeminal autonomic cephalgia

Question 45

All of the following are true for SUNCT headaches:

Answer 45

1. Pain intensity is moderate to severe 2. Pain location is in head, orbital, temporal or trigeminal distribution 3. Pain duration is 1-600 seconds

Question 46

What is the recommended treatment for tension type headaches?

Answer 46

1. NSAIDS not more than 2-3x per week 2. Aspirin and or Acetaminophen with caffeine 2-3x per week 3. Muscle relaxants