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Oral Disease for FINALS > oro-facial pain including chronic facial pain > Flashcards

oro-facial pain including chronic facial pain Flashcards

1
Q

What is the most common facial pain (1)

A

Dental pain

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2
Q

Types of dental pain caused by teeth (4)

A

Caries/ exposed dentine
Pulpal pain
Perapical pain
Cracked tooth syndrome

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3
Q

Types of dental pain caused by gingiva/ periodontium (6)

A 
Periodontitis
Pericoronitis
Malignancy
Periodontal abscess
Lateral periodontal lesion
Trauma (direct; ortho; bruxism)
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4
Q

Types of dental pain caused by bone (1)

A

Osteomyelitis

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5
Q

Other types of dental pain (2)

A

Post operative pain

Referred dental pain

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6
Q

Examples of aggravating/ alleviating factors (6)

A 
Effect of functional activities
-talking,chewing,washing,lying down
Parafunctional activities
-clenching,grinding,habits
Hot/cold
Sleep disturbance
Analgesic usefulness
Stress (relationship to)
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7
Q

Location of pain - where exactly? (3)

A

Deep/Superficial/skin
In the tooth “a toothache”
In the bone /under the tooth

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8
Q

Character-types of pain (6)

A 
Sharp
Shooting
Throbbing
Aching
Burning
Nagging/terrifying
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9
Q

Frequency of pain (4)

A 
Constant
Intermittent
Now and then
Paroxsysms  
-an uncontrollable outburst
-a sudden attack
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10
Q

Associated symptoms with pain (4)

A

Clicking /noise of jaw
Tearing
Facial flushing
Swelling

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11
Q

Epidemiology of chronic facial pain (1)

A

7-14% of population MAY have chronic facial pain

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12
Q

What parts of pain history are important with chronic pain? (2)

A

Family history

Social history

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13
Q

How many people get toothache? (1) Lipton et al 1993

A

12% of population in previous 6 months

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14
Q

Acute pulpitis symptoms (5)

A 
Difficult to localise
Changes with time
Hypersensitive to stimuli
Poor response to analgesics
Vital
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15
Q

Diagnosing cracked tooth syndrome (1)

A

Worsened by biting

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16
Q

Diagnosing hypersensitivity (1)

A

In response to cold/ sweet

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17
Q

Diagnosing periapical periodontitis (3)

A

Localised
Painful to bite
Non vital

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18
Q

Types of osteitis (2)

A

Dry socket- acute alveolitis

Osteomyelitis /BRONJ/MRONJ

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19
Q

Symptoms of osteitis (4)

A

Deep throbbing pain, difficulty sleeping,

frequent bad taste, foul odour

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20
Q

Paraesthesia in osteitis (1)

A

pathognomonic of osteomyelitis

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21
Q

Post-operative pain - features (5)

A 
Inflammatory pain 
Mediated by AA pathway
Good surgical technique can minimise
NSAID’s
3rd molar model -analgesic trials
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22
Q

Referred dental pain (4)

A

Fairly common from headache
Referred from another quadrant
Cardiac tooth pain - rare
Sinusitis

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23
Q

Maxillary sinusitis definition (2)

A

Constant burning pain with zygomatic and dental tenderness from the inflammation of the maxillary sinus
IASP 1994

24
Q

Maxillary sinsusitis symptoms (4)

A
  • C/O purulent rhinorhea
  • recovery from a nasal cold and then a worsening of symptoms
  • O/E purulent secretions in the nasal cavity
  • ESR above 10mm per hour
25
Q

Normal sinus functioning depends on (3)

A
  • patent ostia
  • satisfactory ciliary functioning
  • appropriate amount of secretions
26
Q

Oral dysaesthesia - aetiology (1)

A

Unknown

27
Q

Management of oral dysaesthesia (2)

A

CBT improved 6/12

Oestrogen increased taste

28
Q

Prognosis of oral dysaesthesia (1)

A

Unknown

29
Q

Trigeminal neuralgia definition (1)

A

A sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve
IASP 1994

30
Q

Atypical facial pain (2)

A

I. present daily and persist for most or all of the day
II. should be confined at onset to a limited area of one or both sides of the face, but may spread to the upper or lower jaws and a wider area of the face and neck
III. should not be associated with sensory loss
or other physical signs
IV. Laboratory investigations should not
demonstrate relevant abnormalities
The pain may be initiated by trauma, but persist
without any demonstrable local cause

31
Q

Atypical odontalgia definition (1)

A

Severe throbbing pain in the tooth without major pathology

IASP 1994

32
Q

TMJ pain types (5)

A 
Costens syndrome
Temporomandibular joint dysfunction syndrome (TMD)
Myofascial pain syndrome
Facial arthromyalgia
Oromandibular pain
33
Q

TMJ pain definition (1)

A

Pain in the TMJ and muscles of mastication,
which may worsen upon chewing, possibly
leading to restricted jaw movement

after IASP 1994

34
Q

Management of chronic pain (3)

A
  1. Assessment and diagnosis
    - ensure no cause of concern
  2. Explanation and reassurance
  3. Discuss/ suggest tx options
35
Q

Biophyschological assessment (3)

A

Biological
Psychological - anxiety/ depression
Social context - work/ finances/ family

36
Q

What is oral dysaesthesia? (1)

A

Burning pain in tongue from any cause

37
Q

Local causes and diagnostic tools for burning mouth (7)

A 
Bacterial - oral swabs
Fungal - oral rinse for candida
Allergy - patch test
Geographic tongue - observe over time
Parafunction - dental examination
Oesophageal reflux - tooth erosion
Xerostomia - salivary flow rates
38
Q

Systemic causes of burning mouth (5)

A 
< iron folate B12
Diabetes
Menopause
Psychogenic
Cancerphobia
39
Q

** Chronic pains

A 
TMJ Neuralgic Atypical Vascular
Location Temple, ear,
jaws, teeth
Nerve distribution Diffuse, deep
?across midline
Orbit or upper
face
Localisation Poor, but usually
unilateral
Fair to good Poor Usually good
Duration Weeks to years Seconds Weeks to years Minutes to hours
Character Dull, continuous Lancinating,
paroxysmal
Dull, boring,
continuous
Throbbing, deep
Precipitating
factors
Chewing,
yawning
Touch, wind,
vibration
Stress, fatigue Alcohol
Signs Limited mouth
opening, ?click
None None Lacrimation, eye
injected
Aetiology Stress,
parafunction
Idiopathic, MS Nerve injury, stress Vasomotor,
?allergic
Treatment Physiotherapy,
behavioural,
antidepressants
Tegretol, nerve
block, neurosurgery
Antidepressants,
behavioural
Triptans
40
Q

Management of oral dysaesthesia (3)

A

Correct deficiencies
Alter medications
Manage symptoms

41
Q

Positive trials for oral dysaesthesia (5)

A 
Topical clonazepam
Antidepressants
Alpha-lipoic acid
Capsaicin capsule
Cognitive behavioral therapy -EB
42
Q

What is atypical odontalgia? (1)

A

Severe throbbing pain in the tooth without major pathology

43
Q

What is atypical odontalgia (3)

A 
• Pain associated with a tooth or tooth
socket without any major pathology
• Precipitated by dental procedures
• If the tooth is extracted the pain often
recurs after a few weeks at a new site
44
Q

Phantom tooth pain or AO (3)

A 
• Toothache with no dental pathology
• Constant throb or ache
• Dental treatment
– no difference
– Improvement for a week
45
Q

Removal of a tooth with atypical pain –> outcomes (3)

A

•Pain remains same (with no tooth)
•Pain moves to adjacent teeth
•Pain in gingival tissue that previously
surrounded tooth

46
Q

Aetiology of atypical odontalgia (5)

A 
 Sensitisation of nerves may occur after infection, extraction or even RCT
 Changes within the CNS and
possibly ongoing neural activity
 ?? Female prevalence
 Tends to be older patients
 ?? Psychosocial factors
47
Q

Abnormal pain responses and examples (4)

A

At the site of injury or no injury e.g. chronic
pain, abnormal pain responses can occur
e.g. phantom limb pain, AFP, traumatic lingual nerve dysaesthesia

48
Q

What is hyperalgesia (1)

A

Stimulation is more painful

49
Q

What is allodynia (1)

A

Non painful stimuli are painful

50
Q

What is spontaneous pain (1)

A

Pain in absence of stimulus

51
Q

Central sensitisation/ secondary hyperalgesia - changes in behaviour of central (SC) cells (4)

A
  • Induced by tissue injury
  • Increased spontaneous background firing
  • Hyperexcitability to other low threshold input
  • Increased size of receptive fields
52
Q

Pain enhancement - wind up (1)

A

central, enhanced responsiveness and increased AP firing rate leading to increased perceived pain intensity

53
Q

Describe atypical odontalgia (8)

A

Location Diffuse, deep ?across midline
Localisation Poor, does not fit anatomical boundaries of Trigeminal Nerve
Duration Weeks to years
Character Dull, boring, continuous, can be throbbing, aching “like a toothache”
Precipitating
factors
Stress, fatigue, nil
Signs None
Aetiology Nerve injury, stress
Treatment Antidepressants, behavioural (CBT)
LA block does not help

54
Q

Possible types of therapy for atypical odontalgia (4)

A 
•stress management - ? through GMP
•relaxation / hypnosis
•cognitive behaviour therapy, CBT
(probably includes both of above)
•psychological help for other problems inc.
talking therapy
55
Q

What is CBT? (4)

A

It is a way of talking about:
•how you think about yourself, the world and
other people
•how what you do affects your thoughts and
feelings.
CBT can help you to change how you think
(‘Cognitive’) and what you do (‘Behaviour’).
These changes can help you to feel better

56
Q

Analgesic antidepressant drugs (3)

A

• As helpful with chronic pain with known
pathology as with unknown pathology or
aetiology
e.g.Chronic arthritis, post herpetic neuralgia
• Mainstay of management of AFP/AO
• Amitriptyline/nortriptyline 10-100mg nocte

57
Q

Abnormal signs (3)

A

• Abnormal cranial nerve testing results
– Abnormal sensations
– Abnormal responses
• Vomiting/Headache - ICP

Oral Disease for FINALS (34 decks)

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