Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

module 8 > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

what does ICOP stand for

A

international classification of orofacial pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the 2 main systems used in orofacial pain classification

A
  • international classification of headache disorders 2018
  • international classification of orofacial pain 2020
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what 5 categories are within orofacial pain attributed to disorders of dentoalveolar and anatomically related structures

A
  • tooth related pain
  • pain from periodontium
  • pain from oromucosa
  • pain from salivary glands
  • pain from bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what type of pain do groups 2 and 3 of ICOP include

A

TMJ pain/ disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which nerves are of significance in orofacial pain attributed to lesion or disease of the cranial nerves

A
  • trigeminal
  • glossopharyngeal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what two categories are within pain attributed to lesion or disease of the trigeminal nerve in ICOP

A
  • trigeminal neuralgia
  • painful trigeminal neuropathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what two categories are within pain attributed to lesion or disease of the glossopharygeal nerve

A
  • glossopharyngeal neuralgia
  • painful glossopharygeal neuropathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the most widely accepted classification of orofacial pain

A

ICHD3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what 4 categories are within orofacial pains resembling presentations of primary headaches

A
  • migraine
  • tension headache (TTH)
  • trigeminal autonomic cephalalgias (TACs)
  • other primary headache disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what 3 categories come under idiopathic orofacial pain

A
  • burning mouth syndrome
  • persistent idiopathic facial pain
  • persistent idiopathic dentoalveolar pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is an innocuous stimulus

A

something that wouldnt normally give rise to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is trigeminal neuralgia

A

recurrent unilateral pains, abrupt in onset and termination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

does trigeminal neuralgia always have a cause?

A

no, may develop on its own or as a result of another diagnosed condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what may come along with the short sharp pains of trigeminal neuralgia

A

continuous moderate pain in the distribution of the affected nerve(s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how long will trigeminal neuralgia pain last

A

a few seconds - 2 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what does the pain of trigeminal neuralgia feel like

A

severe, sharp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the pain of trigeminal neuralgia caused by

A

innocuous stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

give an example of innocuous stimulus

A

yawning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the final part of diagnosing trigeminal neuralgia

A

not better accounted for by any of the other ICHD-3 diagnosis’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the incidence of trigeminal neuralgia

A

4-13:100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what age does trigeminal neuraligia often affect

A

50-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what age group is trigeminal neuralgia very uncommon in

A

less than 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what would be suspicious of if a ot under 40 has trigeminal neuralgia

A

underlying disease process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what gender does trigeminal neuralgia affect more

A

female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are the risk factors for trigeminal neuralgia

A

stroke
hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

is trigeminal neuralgia usually bilteral or unilateral

A

unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

which side of the face does trigeminal neuralgia affect more commonly

A

right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what would you suspect if a pt has bilateral trigeminal neuralgia

A

underlying disease process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what % of trigeminal neuralgia affects the opthalmic division

A

<5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what % of trigeminal neuralgia is related to dental Tx or disease

A

22%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what might dental Tx or disease cause trigeminal neuralgia

A

sensitisation of the nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what % of pts consult a dentist first for trigeminal neuralgia

A

27%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what % of pts have pain free periods in trigeminal neuralgia

A

73%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what % of pts have a provoking factor in trigeminal neuralgia

A

96%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is often a relieving factor for pts with trigeminal neuralgia

A

warmth and rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the refractory period in trigeminal neuralgia

A

time after the pain where the trigger will no longer illicit a response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

why is lachrymation an associated factor of trigeminal neuralgia

A

as pain so severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what other conditions may be associated with trigeminal neuralgia

A

depression and anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

if the pain of trigeminal neuralgia is so bad, what may you be concerned about for your pt

A

suicide risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what are the 3 classifications of trigeminal neuralgia

A
  • classical trigeminal neuralgia
  • secondary trigeminal neuralgia
  • idiopathic trigeminal neuralgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is classical trigeminal neuralgia

A

develops without apparant cause other than neurovascular compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what does compression of the nerve in trigeminal neuralgia cause that results in pain

A

demyelination of the nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

where will morphological changes occur in classical trigeminal neuralgia

A

trigeminal nerve root

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

where is the trigeminal nerve root

A

posterior cranial fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

how can you demonstrate the compression of nerves in classical trigeminal neuralgia

A

MRI
surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what usually cause the compression in classical trigeminal neuralgia

A

blood vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

where is the area of most vulnerability for classical trigeminal neuralgia

A

root entry zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

why is the root entry zone the area of most vulnerability for classical trigeminal neuralgia

A

where the peripheral and central myelins of schwann cells and astrocytes meet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

describe the symptoms of classical trigeminal neuralgia

A

classical trigeminal neuralgia with persistent background facial pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is secondary trigeminal neuralgis caused by

A

underlying disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what will a clinical exam of a pt with secondary trigeminal neuralgia show

A

significant sensory changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what distinguishes secondary from classical trigeminal neuralgia

A

a diagnosis of underlying disease known to cause neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

name 2 diseases known to cause secondary trigeminal neuralgia

A

MS
space occupying lesion eg tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what age group do secondary trigeminal neuralgia belong to

A

<30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

is secondary trigeminal neuralgia bilateral or unilateral

A

bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what imaging should be taken for trigeminal neuralgia

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is idiopathic trigeminal neuralgia

A

trigeminal neuralgia with no tests showing significant abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

how is idiopathic trigeminal neuralgia often diagnosed

A

neither classical or secondary trigeminal neuralgia has been confirmed by any tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what must an exam for trigeminal neuralgia include

A

cranial nerve exam –> CNV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what areas are imaged in an MRI for trigeminal neuralgia

A

head and internal auditory meatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is the diagnosis of facial pain reliant on

A

pain history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

who should the GDP liaise with for trigeminal neuralgia

A

GP
oral med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

when should there be urgent referral to a specialist oral med

A
  • sensory/ motor deficits
  • deafness/ ear problems
  • optic neuritis
  • history of malignancy
  • bilateral TN pain
  • systemic symptoms - fever, weight loss
  • presentation in pts <30
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what is the first line pharmacological Tx for trigeminal neuralgia

A

carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

can GDPs prescribe carbamazepine

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what can pts contraindicated/ not tolerant of carbamazepine take for trigeminal neuralgia

A

oxycarbazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what is the brand name for carbamazepine

A

tegretol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what type of drug is carbamazepine

A

anticonvulsant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what is carbamazepine liscensed for

A

bipolar and epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

how does carbamazepine work

A

binds to voltage dependant Na channels inhibiting action potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

where is carbamazepine metabolised

A

liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what enzymes metabolise carbamazepine

A

CYP3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

why is the enzyme that metabolises carbamazepine important?

A

interactions with drugs that are metabolised by the same systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what causes reduction of efficacy sometimes seen after the first few weeks of carbamazepine Tx

A

induces its own metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what % of carbamazepine is excreted in the urine

A

70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what ethnicity of pts should carbamazepine not be prescribed to

A

han chinese/ thai origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

why can carbamazepine not be prescribed to han chinese/ thai pts

A

increased likelihood of steven johnsons syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what testing is required to rule out steven johnsons syndrome

A

testing for HLAB*1502 allele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what does prescription of carbamazepine to steven johnson syndrome pts result in

A

extensive mucosal and skin ulceration and blistering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what can carbamazepine cause in pregnant pts

A

congenital malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what are 3 interacting drugs with carbamazepine

A
  • st johns wort
  • alcohol
  • grapefruit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what advice must pts taking carbamazepine be given

A

how to recognise disorders of liver, skin and bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what is required if the pt on carbamazepine develops rash, fever, mouth ulcers, bruising or bleeding

A

immediate medical attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what oral relevant side affect is there of carbamazepine

A

dry mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

why are baseline blood tests taken for carbamazepine

A

potential effects on bone marrow, liver and renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the dose prescribed for carbamazepine

A

100mg x2 day for 1-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what is the therapeutic range per day for carbamazepine

A

800-1200mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what should be done once a trigeminal neuralgia pt taking carbamazepine is pain free for 4 weeks

A

trial dose reduction of carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

how often should monitoring blood tests be taken for pts on carbamazepine

A

weekly for first 4 weeks
then 1-3 monthly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what happens if a blood test for a pt on carbamazepine show abnormality

A

stop or dose reduction of carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

where can oxcarbazepine be prescribed

A

secondary care - not GDP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

name 4 second line pharmacological Tx for trigeminal neuralgia

A
  • lamotrigine
  • baclofen
  • gabapentin
  • pregabalin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what additional management to pharmacological Tx can be given to pts with trigeminal neuralgia

A
  • lidocaine nasal spray
  • lidocaine ointment
  • lidocaine as infil to trigger point
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what dose of lidocaine nasal spray can be given to TN pts

A

10mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

when would lidocaine nasal spray be given to TN pts

A

for maxillary pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

where would lidocaine ointment be applied for TN pts

A

trigger point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what can a lidocaine infiltration to the trigger point of TN pts also be used as, as well as pain relief

A

diagnostic tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

what national support groups may be useful for TN pts

A
  • trigeminal neuralgia association UK
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what can be recommended to the pt if medication doesnt work to manage trigeminal neuralgia

A

surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

when is surgery particularly relevant to trigeminal neuralgia

A
  • medical management ineffective
  • medication not tolerated
  • medication contra-indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

name 3 indications for surgery to managed trigeminal neuralgia

A
  • short/no pain free period
  • complications
  • adverse affect on quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what is done in surgical management of trigeminal neuralgia

A

palliative destruction at level of the grasserion ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

how is destruction of the grasserion ganglion done in surgery for trigeminal neuralgia

A
  • radiofrequency thermocoagulation
  • glycerol rhizolysis
  • balloon compression
  • steriotactic radiosurgery - gamma knife
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what surgery is usually used in classical trigeminal neuralgia

A

microvascular decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what 3 surgeries can be used in trigeminal neuralgia

A
  • microvascualr decompression
  • partial sensory rhizotomy
  • internal neurolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what surgery is done for trigeminal neuralgia if there is no neurovascular compression

A

neuroabalative procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what is the role of the GDP in trigeminal neuralgia

A
  • diagnosis
  • exclusion of dental pathology
  • initiate medical treatment with GMP
  • referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what category does glossopharyngeal neuralgia come under

A

painful lesions fo the cranial nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what other distribution of nerve can glossopharyngeal neuralgia be felt?

A

vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

where is pain often experienced in glossopharyngeal neuralgia

A
  • ear
  • base of the tongue
  • tonsillar fossa
  • beneath angle of mandible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what is glossopharyngeal neuralgia commonly provoked by

A

swallowing, talking and coughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what divisions are there of glossopharyngeal neuralgia

A
  • classical
  • secondary
  • idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

what investigation would be done for glossopharyngeal neuralgia

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what systemic management is there for glossopharyngeal neuralgia

A

carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what other category of conditions is grouped in with glossopharyngeal neuralgia and trigeminal neuralgia under painful lesions of the cranial nerves

A

painful trigeminal neuropathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

name the 3 categories of painful trigeminal neuropathies

A
  • painful trigeminal neuropathy attributed to the herpes zoster virus
  • trigeminal post-herpetic neuralgia
  • painful post-traumatic trigeminal neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what is allodynia

A

pain in response to a stimulus which would not normally cause pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what is hyperalgesia

A

increased response to a stimulus which would normally cause pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is hypoalgesia

A

reduction in response to a stimulus which would normally cause pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what is hyperesthesia

A

increased cutaneous/mucosal sensitivity to a stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what is dysesthesia

A

unpleasant/ abnormal sensation affecting the skin or mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what is pain in painful trigeminal neuropathies indicative of

A

neural damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

how does the primary pain in painful trigeminal neuropathies feel

A

continuous burning/squeezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what may occur along with the primary pain in painful trigeminal neuropathies

A

brief pain that isnt the predominant pain type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

how do the allodynic areas in painful trigeminal neuropathies differ from the trigger zones in trigeminal neuralgia

A

allodynic areas are much larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what is painful trigeminal neuropathies attributed to the herpes zoster virus

A

unilateral facial pain of less than 3 months to one or more branches of the trigeminal nerve and associated symptoms of herpes zoster virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what is acute herpes zoster

A

shingles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what is post herpetic painful trigeminal neuropathy

A

unilateral pain for more than 3 months caused by the herpes zoster virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

how can pts avoid shingles

A

vaccines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

who can get the herpes zoster vaccine

A

70-79 year olds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

how is post-herpetic trigmeinal neuralgia avoided

A

antivirals up to 72 hrs following the appearance of shingles

132
Q

what antivirals are given for shingles to avoid post-herpetic TN

A

aciclovire

133
Q

what is the immediate management for post herpetic TN

A

paracetamol and codeine

134
Q

what self management techniques are given to pts with painful trigeminal neuropathies

A
  • relaxation
  • distraction
  • exercise
  • mindfulness
135
Q

what topical agents can be given for painful trigeminal neuropathies

A
  • lidocaine patches
  • capsaicin cream
136
Q

what systemic agents can be given for painful trigeminal neuropathies

A
  • duloxetine
  • amltriptylene
  • amantadine
137
Q

who are topical and systemic agents for painful trigeminal neuropathies prescribed by

A
  • specialist
  • GMP
138
Q

which is the only type of painful trigeminal neuropathies which can be bilateral

A

painful post traumatic TN

139
Q

what is post traumatic T neuropathies

A

unilateral/ billateral facial pain following and caused by trauma to trigeminal nerve

140
Q

how would you diagnose post traumatic TN

A

identifiable event with signs of nerve dysfunction

141
Q

how long within the traumatic event does post traumatic TN have to develop to be classified as such

A

<6 months

142
Q

what nerves does idiopathic orofacial pain affect

A

trigeminal

143
Q

what does idiopathic mean

A

unknown cause

144
Q

what is the intensity of idiopathic orofacial pain

A

moderate

145
Q

how does idiopathic orofacial pain feel

A

dull, pressing or burning sensation

146
Q

name 3 members of idiopathic orofacial pain

A
  • persistent idiopathic facial pain
  • persistent idiopathic dentoalveolar pain
  • burning mouth syndrome
147
Q

what are the basic features of idiopathic orofacial pain

A
  • daily pain
  • > 2hrs duration per day
  • no apparent abnormality
148
Q

what is significant about conventional analgesics in idiopathic orofacial pain

A

ineffective

149
Q

what medical histories are often related to idiopathic orofacial pain

A
  • chronic pain elsewhere in the body
  • contact with pain services
  • depression/anxiety
150
Q

what is the role of the GDP inidiopathic orofacial pain

A
  • pain history
  • exclude dental cause
  • check cranial nerves
  • reassure and self management techniques
  • refer
151
Q

what therapy may be available for idiopathic orofacial pain

A
  • cognitive behavioural therapy
  • acceptance and commitment therapy
152
Q

what are topical treatments for idiopathic orofacial pain dependant on

A

site and type of pain

153
Q

name 4 systemic treatments for idiopathic orofacial pain

A
  • amitriptylene
  • duloxetine
  • fluoxetine
  • gabapentin/ pregabalin
154
Q

what type of drug is amitriptylene

A

tricyclic

155
Q

when might pts particularly benefit from gabapentin/ pregabalin

A

when the pain has a neuropathic component

156
Q

how would you know the pain in idiopathic orofacial pain has a neuropathic component

A

sharp shooting pain

157
Q

who, other than a specialist, can you refer the pt to for idiopathic orofacial pain

A

pain management services

158
Q

what was persistent idiopathic orofacial pain previously known as

A

atypical facial pain

159
Q

what characteristics does persistent idiopathic orofacial pain have

A
  • > 2hrs per day for >3 months
  • poorly localised not following the peripheral distribution of the nerve
  • dull aching quality
160
Q

who does persistent idiopathic orofacial pain affect more commonly

A

females

161
Q

what % of persistent idiopathic orofacial pain is bilateral

A

14-19%

162
Q

what % of pts have pain free months in persistent idiopathic orofacial pain

A

17-35%

163
Q

name some relieving factors of persistent idiopathic orofacial pain

A
  • warmth
  • pressure
  • medication
164
Q

name some provoking factors of persistent idiopathic orofacial pain

A
  • stress
  • cold weather
  • chewing
  • head movements
  • life events
165
Q

name 3 associated factors of persistent idiopathic orofacial pain

A
  • dental Tx
  • psychiatric conditions
  • altered sensations
166
Q

what may persistent idiopathic orofacial pain be preceded by

A
  • dental Tx
  • minor injury
  • operation
167
Q

what investigations may be taken for persistent idiopathic orofacial pain

A
  • MRI
  • CBCT
  • CT
168
Q

when would special investigations be taken for persistent idiopathic orofacial pain

A
  • pain has neuropathic component
169
Q

what would you do if the pt has persistent idiopathic orofacial pain with sensory deficit on checking CNV

A

CBCT
CT
MRI

170
Q

what is the only topical treatment that a GDP can prescribe

A

lidocaine ointment

171
Q

what is the first line systemic treatment for persistent idiopathic orofacial pain

A

amitriptylene

172
Q

what might some cases of persistent idiopathic orofacial pain match the description of

A

painful post-traumatic trigeminal neuropathy

173
Q

what was peristent idiopathic dentoalveolar pain previously known as

A

atypical odontalgia

174
Q

is peristent idiopathic dentoalveolar pain unilateral or bilateral

A

unilateral

175
Q

how often does peristent idiopathic dentoalveolar pain occur

A

> 2hrs per day for >3months

176
Q

what characteristics does peristent idiopathic dentoalveolar pain have

A
  • localised to dentoalveolar site
  • deep dull pressure
177
Q

name some provoking factors of peristent idiopathic dentoalveolar pain

A
  • hot and cold
  • dental Tx
  • pressure on tooth
178
Q

name 3 relieving factors of peristent idiopathic dentoalveolar pain

A
  • warmth
  • pressure
  • medication
179
Q

name 6 associated factors of peristent idiopathic dentoalveolar pain

A
  • bruxism
  • emotional problems
  • hypersensitivity to hot and cold
  • anxiety
  • depression
  • hypotensive therapy
180
Q

what is the incidence of peristent idiopathic dentoalveolar pain after dental Tx involving removal of a sensory nerve

A

1.6%

181
Q

what topical Tx may be indicated for peristent idiopathic dentoalveolar pain

A

lidocaine ointment 5%/ spray 10%

182
Q

what was burning mouth syndrome previously known as

A

oral dysaesthesia

183
Q

what can the sensation of burning mouth syndrome be described as

A

dysaesthetic

184
Q

what characteristics does burning mouth syndrome have

A
  • burning quality of pain
  • felt superficially in the oral mucosa
185
Q

what has to be excluded before diagnosis of burning mouth syndrome

A

local o r systemic causes

186
Q

what else may accompany burning mouth syndrome apart from the burning pain

A

taste disturbance

187
Q

what is the incidence of burning mouth syndrome in the general population

A

1-15%

188
Q

what is the incidence of burning mouth syndrome in post menopausal women

A

18-33%

189
Q

who does burning mouth syndrome affect more by what ratio

A

women 3:1

190
Q

what is there evidence of in post menopausal women that may contribute/ cause burning mouth syndrome

A

changes in peripheral nerves supplying the lining of the mouth and tongue

191
Q

what sites does burning mouth syndrome affect

A
  • lips
  • palate
  • tongue
192
Q

which site is most commonly affected in burning mouth syndrome

A

tongue

193
Q

is there any mucosal abnormality that accounts for the symptoms of burning mouth syndrome

A

no

194
Q

what local factors must be excluded in order to diagnose burning mouth syndrome

A
  • parafunctional habits
  • dry mouth
  • GORD
  • candidioses
195
Q

what symptoms of GORD may imitate burning mouth syndrome

A

burning of the posterior of the mouth

196
Q

what systemic causes have to be excluded to diagnose burning mouth syndrome

A
  • anaemia
  • haematinic deficiency
  • diabetes
  • thyroid dysfunction
  • medication
197
Q

what medication may imitate burning mouth syndrome

A

ACE inhibitors

198
Q

when might diabetes imitate burning mouth syndrome

A

undiagnosed/ poorly controlled

199
Q

what investigations would be taken to exclude any systemic causes of the symptoms of burning mouth syndrome

A
  • FBC
  • haematinics
  • RBG/HbA1c
  • TSH
    -Zn
  • sialometry
200
Q

when would serum zinc tests be needed to diagnose burning mouth syndrome

A

if taste disturbance

201
Q

how would candidal infection be ruled out in diagnosing burning mouth syndrome

A

swab/ oral rinse

202
Q

what would be prescribed in primary care for the management of burning mouth syndrome

A
  • benzydiamine as mouthwash or oromucosal spray
203
Q

what would be prescribed in secondary care for the treatment of burning mouth syndrome

A
  • capsaicin mouthwash
  • clonazepam oral rinse
204
Q

how would a pt with burning mouth syndrome make up capsaicin mouthwash

A

mix tobasco with water

205
Q

what is Xerostomia?

A

sensation of a dry mouth

206
Q

what is xerostomia dependant on

A

subjective - dependant on the pts experince

207
Q

what is a symptom

A

subjective evidence of a disease

208
Q

what is a sign

A

an objective physical finding

209
Q

how long does the pt have to have had a dry mouth for to consider sjogrens

A

> 3 months

210
Q

what medical factors may cause a dry mouth

A
  • polypharmacy
  • diabetes
  • radio/chemotherapy
211
Q

how would you know that dry mouth is medication related

A

lines up with when the pt started taking the medication

212
Q

what in the dental history may indicate a dry mouth

A
  • increase in caries
  • difficulty wearing dentures
  • soreness in mouth when previously symptom free
213
Q

what type of caries is more common in dry mouth

A
  • smooth surface/cervical
214
Q

what 3 factors in the SH may be related to dry mouth

A
  • smoking
  • alcohol
  • stress
215
Q

why does alcohol cause dry mouth

A

dehydration

216
Q

what family history may lead you to suspect a pt with dry mouth may have secondary sjogrens

A
  • any connective tissue disorders
  • rhematoid arthritis
  • lupus
217
Q

what would a challacombe score of 1-3 indicate

A

mild dryness

218
Q

how would you treat scores 1-3 on challacombe

A

routine check ups and monitoring

219
Q

at does a challacombe score of 4-6 indicate

A

moderate dryness

220
Q

how would you treat scores 4-6 on challacombe

A

further investigation if cause not clear

221
Q

is there any need to refer if the cause of moderate oral dryness is clear

A

no

222
Q

what would a challacombe score of 7-10 indicate

A

severe dryness

223
Q

how would you treat a challacombe score of 7-10

A

refer - even if you know the cause

224
Q

why does the cause of a challacombe score of 7-10 need to be determined

A

to rule out sjogrens

225
Q

when would a pt be given saliva substitutes

A

challacombe 7-10

226
Q

when would a pt be given sialogogues

A

challacombe 4-6

227
Q

what else might you find in a pt with dry mouth

A
  • oral candidiasis
  • traumatic ulceration
  • poor denture retention
  • bacterial sialadenitis
228
Q

name 4 symptoms of oral candidiasis

A
  • angular chelitis
  • erythematous mucosa
  • thrush
  • denture stomatitis
229
Q

how might objective evidence of a salivary flow rate be obtains

A

unstimulated saliva flow rate test

230
Q

how long does unstimulated saliva flow rate test take

A

15 mins

231
Q

what is the normal flow rate of saliva

A

> 0.2ml/min

232
Q

what would be significantly reduced rate of saliva flow

A

<0.1ml/min

233
Q

why cant the pt spit or talk during unstimulated salivary flow test

A

will stimulate saliva

234
Q

is the stimulated salivary flow rate test of diagnostic significance

A

no

235
Q

what will the stimulated salivary flow rate test provide

A

therapeutic help - will indicate whether the salivary glands will respond to stimulation

236
Q

what should the treatment be if the stimulated salivary flow rate test is significantly decreased in its results

A

saliva replacements as the glands wont respond to stimulation

237
Q

what gland should be used for stimulated salivary flow rate test

A

parotid

238
Q

what is the normal stimulated salivary flow rate

A

0.4ml/min

239
Q

what do viruses HIV and hep C do that cause dry mouth

A

cause changes similar to sjogrens that cause hypofunction

240
Q

what condition causes changes in oral mucosa similar to that of oral granulmatosis and chrones

A

sarcoidosis

241
Q

what symptoms to chrones cause in the mouth

A
  • lip swelling
  • salivary glands lymphadenopathy
242
Q

what symptoms does oral granulmatosis cause in the mouth

A
  • lip swelling
  • salivary gland lymphadenopathy
243
Q

what symptoms does sarcoidosis cause in the mouth

A
  • lip swelling
  • salivary gland lymphadenopathy
244
Q

what oral condition does graft vs host disease mimic in the mouth h

A

lichen planus/ lichenoid reaction

245
Q

what is salivary gland aplasia

A

gland fails to develop

246
Q

how does cystic fibrosis cause dry mouth

A

causes damage to the salivary glands

247
Q

does the removal of a major salivary gland lead to dry mouth

A

no

248
Q

why does removal of a major salivary gland not lead to dry mouth

A

other glands compensate for it

249
Q

why do people get age related dry mouth

A
  • age related changes to the salivary glands
  • polypharmacy
250
Q

why would a good SH be relevant to dry mouth

A

may be very stressed/ smoker/ high alcohol intake

251
Q

what does saliva production drop to during sleep

A

0.1ml/min

252
Q

why is mouth breathing sleep really bad for dry mouth pts

A

saliva production is already reduced during sleep

253
Q

what is the test of choice for diabetes pts to know their blood glucose concentration

A

glycosylated haemoglobin

254
Q

how many medications have strong evidence of causing dyr mouth

A

56

255
Q

what medications are known to often interact with saliva production

A

urologicals, nervous system drugs

256
Q

radiotherapy pts can have some recovery of saliva function after having had Tx, what time frame can this occur within

A

6 to 12 months

257
Q

12 months after having had radiotherapy, is the pts salivary function likely to improve

A

no

258
Q

what type of gland is more susceptible to radiotherapy Tx

A

serous

259
Q

how long after chemotherapy will salivary gland function recover

A

2-8 weeks

260
Q

does dry mouth after chemotherapy persist

A

not usually - scute symptoms

261
Q

what % of the population suffer from sjogrens syndrome

A

3-4%

262
Q

what type of disease is sjogrens

A

autoimmune chronic inflammatory condition

263
Q

what does the body produce against salivary gland cells in sjogrens syndrome

A

polyclonal B cells

264
Q

what happen secondary to infiltration by lymphocytes in sjogrens ysndrome

A

acinar atrophy

265
Q

what can sjogrens syndrome affect

A

all exocrine glands

266
Q

what places will the pt usually complain of being symptomatic in sjogrens syndrome

A
  • mouth
  • eye s
267
Q

what % of sjogrens syndrome pts are women

A

90

268
Q

what is the average age on onset for sjogrens syndrome

A

50

269
Q

what is secondary sjogrens accompanied by

A

connective tissue disorder

270
Q

give four examples of connective tissue disorders accompanying sjogrens syndrome

A
  • rheumatoid arthritis
  • lupus erythematous
  • systemic sclerosis
  • primary biliary sclerosis
271
Q

how many salivary glands are harvested in minor labial salivary gland biopsy

A

3-4

272
Q

which tests for sjogrens can be done outwith the dentsit

A
  • ocular staining score
  • lacrimal flow rate
273
Q

what is the lacrimal flow rate also known as

A

schirmir tets

274
Q

what is the most basic salivary gland tests that can be done to tests for sjogrens syndrome

A

unstimulated whole salivary flow rate test

275
Q

what must you warn the pt of in advance for minor salivary gland biopsy

A

paraesthesia of the area plus 15mm periphery

276
Q

why is there risk of paraesthesia in minor salivary gland biopsy

A

lots of nerves in the area that can get damaged

277
Q

what chance of paraethesia is there in minor salivary gland biopsy

A

1%

278
Q

what classification criteria is used for the diagnosis of primary sjogrens syndrome

A

american college of rheumatology ACR/ european league against rheumatism 2016

279
Q

what score on the classification score does a pt have to have to be diagnosed with sjogrens

A

4

280
Q

who manages systemic involvement of sjogrens syndrome

A

rheumatologist

281
Q

what do pts have an increased risk of in primary sjogrens

A

lymphoma

282
Q

why is diagnosis of sjogrens important

A
  • increased risk of lymphoma
  • may lead to diagnosis of connective tissue disorder
283
Q

what must a GDP decide on diagnosis dry mouth

A

if referral is needed

284
Q

what is sicca syndrome

A

dry mouth and eyes without an accompanying diagnoses of sjogrens

285
Q

why is stimulation of saliva preferable to replacement

A

replacements dont recreate the composition of saliva

286
Q

what tool can help in the management of dry mouth pts

A

challacombe scale

287
Q

what are some replacement saliva products sepcific to

A

radiotherapy or sicca syndrome pts

288
Q

what is most expensive, replacement saliva or stimulants

A

replacement

289
Q

what can GDPs prescribe to stimulate saliva flow

A
  • saliva pastilles
  • saliva stimulating tablets
290
Q

what is in saliva pastilles

A

mixture of citric and malic acid

291
Q

who are saliva stimulating tablets prescribed to

A

only pts with impaired salivary gland function

292
Q

what is an alternative option to prescribing salivary stimulating products

A

stimulate their own saliva flow using sugar free gum/sweets

293
Q

what can be prescribed as systemic therapy for dry mouth

A

pilocarpine

294
Q

where would pilocarpine be prescribed for a pt with dry mouth

A

secondary care

295
Q

when would pilocarpine be prescribed for a dry mouth p t

A
  • H&N cancer pt
  • sjogrens pt
296
Q

what type of inhibitor is pilocarpine

A

acetylcholine esterase

297
Q

what dose of pilocarpine is prescribed for pts with dry mouth

A

5mg

298
Q

who should glandosane oral spray be avoided in

A

dentate pts

299
Q

why should glandosane oral spray be avoided in dentate pts

A

acidic pH

300
Q

what might you need to tell a pt when prescribing saliva arthana

A

mucin derived from pig stomach

301
Q

can saliva replacements be purchased over the counter

A

yes

302
Q

why are gels good for pts with dry mouth at night

A

they stay around in the mouth longer that the sprays

303
Q

other than replacements/stimulants, what else might you want to prescribe to a pt with dry mouth

A

fluoride mouthwash/ toothpaste

304
Q

what infection might a pt with dry mouth get

A

bacterial sialadenitis

305
Q

what microbe causes bacterial sialadenitis

A

staph aureus

306
Q

what would you prescribe for bacterial sialadenitis

A

flucloxacilin

307
Q

what is the name for excessive saliva production

A

sialorrhea

308
Q

why might sialorrhea be seen in parkinsons pts

A

disphagia issues

309
Q

what is sialadenosis

A

salivary gland swelling

310
Q

what is the presentation of sialadenosis

A
  • acute bilateral swelling of parotid glands
311
Q

what is the Tx for lichen planus if the pt is asymptomatic

A

nothing

312
Q

what should the Tx for lichen planus be matched to in a symptomatic pt

A

symptom severity

313
Q

how often should a lichen planus pt be reviewed

A

6 monthly

314
Q

what should a lichen planus pt be advised of

A

potentially malignant disorder

315
Q

what is the incidence of malignant change in lichen planus

A

1%

316
Q

what might be given as topical therapy for lichen planus by GDP

A
  • benzydamine mouthwash/ spray
  • lidocaine ointment 5%
  • lidocaine spray 10%
317
Q

what topical antimicrobial may be given to lichen planus pt by GDP

A

chlorhexidine mouthwash

318
Q

what topical steroids can be given to a lichen planus pt by GDP

A
  • betamethasone tablets 500mg
  • clenil modulate 50mg inhalation
  • hydrocortisone oromucosal tablets
319
Q

what is in triple mouthwash prescribed in secondary care for lichen planus

A
  • betamethasone 500mg
  • doxycyclin 100mg
  • nystatin
320
Q

what systemic medication may be given for lichen planus in secondary care

A
  • short course of prednisolone
  • DMARDs
321
Q

what is the management for apthous stomatitis

A
  • diet modification
  • SLS free toothpaste
  • topical analgesic
  • topical steroid
322
Q

what diet modifications may be suggested for apthous stomatitis pts

A
  • cinnamon avoidance
  • benzoate avoidance
323
Q

what antimicrobials can be prescribed for apthous stomatitis by GDP

A
  • chlorhexidine mouthwash
  • doxycycline tablet as mouthwash
324
Q

what topical steroids can be prescribed for apthous stomatitis by GDP

A
  • betamethasone 500mg
  • clenil mouthwash 50 micrograms
  • hydrocortisone oromucosal tablets
325
Q

what management is done in secondary care for apthous stomatitis

A
  • topical steroids
  • triple mouthwash
  • systemic medication
326
Q

what systemic medication is given in secondary care for apthous stomatitis

A
  • short course of predisolone
  • colohione
  • DMARDs

module 8 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions