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BDS5 Oral Med > Orofacial Pain > Flashcards

Orofacial Pain Flashcards

(52 cards)

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1
Q

What is the definition of Orofacial pain?

A

= involves area above the neck, anterior to ears + below orbitomiatal line

-includes pain from oral cavity
- TMD most common facial non-dental (non-odontogenic) pain

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2
Q

List the types of CHRONIC orofacial pain?

A

-TMD
- Persistent idiopathic facial pain (nerve rx after tooth XLA e.g. atypical odontalgia)
- Burning mouth syndrome
- Glossopharyngeal neuralgia
- Trigeminal neuralgia
- Shingle + postherpetic neuralgia
- Headaches (including giant cell arthritis, cluster headaches etc)

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3
Q

How many months defines chronic / persistent pain?

A

pain that has been present for over 3 months

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4
Q

Non-pharmacological means of pain relief?

A
  1. CBT
    (targets cognitive, emotional + behavioural factors
    involves relaxation + behaviour techniques
    decreases pain by addressing psychological aspects
  2. Acupuncture (used for chronic TMD)
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5
Q

What is TMD?

A

Temperomandibular disorders (TMD)

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6
Q

What is TMJD?

A

Temperomandibular Joint Dysfunction Syndrome

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7
Q

What is the definition of TMD/TMJD?

A

Refers to musculoskeletal disorders involving muscles of mastication +/or TMJs

Includes:
1.Myofacial pain disorder (musclar origin)
2.TMJ disc inference disorders (disc displacement w or w/o reduction)
3. TMJ degenerative joint disease (osteoarthritic change)

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8
Q

What are the risk factors for TMJD?

A
  • Depression
  • Multiple pain conditions (back pain, IBS)
  • Female
  • Age 18-44yrs
  • Bruxism
  • Facial trauma
  • Insomnia
  • Exogenous hormone pain
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9
Q

What does SOCRATES for TMD look like?

A

Site- unilateral, bilateral, TMJ area
Character- dull, aching, throbbing
Radiation- pre/post auricular, MoM
Assoc factors- stress, clicking, tender muscles
Timing- intermittent or constant
R/E- rest, analgesics | chewing, opening wide, yawning

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10
Q

What’s the non- pharmacological management of TMD?

A
  • Split therapy
  • CBT
    -Physiotherapy
  • Acupuncture
  • Botox injections
  • Relaxtion/ pt empowerment
  • Warmth to joints
  • Self-massage
    -Jaw exercises
  • Simple analgesics (oral or topical)
  • Tx of parafunctional habits
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11
Q
A
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12
Q

What’s the pharmacological management of TMD?

A

Analgesics:
NSAIDs
Paracetamol
Opoids (if severe)

Corticosteroids:
IM injections

Antidepressants

Muscle Relaxants

Sedative hypnotics

Anxiolytics

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13
Q

What is Glassopharyngeal neuralgia?

A

Severe transient STABBING pain involving ear, base of tongue, tonsillar fossa or beneath angle of jaw

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14
Q

How does glossopharyngeal neuralgia present?

A
  • unilateral
  • initiated by swallowing, chewing, talking or coughing
  • may be pharyngeal or tympanic
  • remissions may occur
  • may be assoc w/ syncope or arrhythmias

(less common than trigeminal neuralgia)

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15
Q

Aetiology of glossopharyngeal neuralgia?

A

Primary reason - nerve compression

Secondary reason- congenital vascular anomalies, tumour or aneurysm
(- persistent background aching pain)

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16
Q

What is the management glossopharyngeal neuralgia?

A
  • Medical management of nerve
  • Nerve decompression
  • Cardiac pacing
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17
Q

What is a KEY/COMMON differential diagnosis for Glossopharyngeal Neuralgia?

A

Eagle Syndrome

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18
Q

What is Eagle syndrome?

A

Throat injury where stylohyoid is elongated, pressing on glossopharyngeal, vagus +/- trigeminal cranial nerves

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19
Q

What are the symptoms of Eagle syndrome?

A
  • shooting pains involving throat ear or jaw, tongue base pain
  • pain when swallowing or turning head
  • tinnitus
  • feeling of something being stuck in throat
  • sensation of hypersalivation
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20
Q

What is the tx for Eagle syndrome?

A

Styloidectomy

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21
Q

What is Trigeminal Neuralgia (TN)?

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A

sudden, (mostly) unilateral, severe, brief, stabbing, recurrent pain in the distribution of 1 or more branches of the 5th cranial nerve at the root entry zone

22
Q

Who does Trigeminal Neuralgia affect?

Study These Flashcards
A

Age onset: 5-6th decade
RF: Hypertension + Multiple Sclerosis

23
Q

What is the classifcation of Trigeminal Neuralgia?

Study These Flashcards
A
  1. Idiopathic - typical or atypical
  2. Secondary:
    - intrinsic pathology i.e. MS; likely bilateral + younger pt
    - extrinsic pathology i.e. posterior fossils tumours or vascular lesions; constant pain
24
Q

What does SOCRATES for Trigeminal Neuralgia look like?

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A

Site- unilateral distribution of trigeminal nerve (usually right)

Character- flashing, shooting, sharp, unbearable, exhausting pain

Radiation- rarely first division

Assoc factors- trigger zones, weight loss

Timing- lasts seconds (complete remission weeks-months)

Relieving factors: avoiding touch, sleep, anticonvulsants

25
What investigations can be conducted for diagnosis of Trigeminal Neuralgia?
FBC Renal profile LFT MRI posterior fossa - to look for nerve root compression (to rule out MS or tumour) Use low dose carbamezipine to rule out MS if they respond to it
26
What is 1st line tx for Trigeminal Neuralgia?
1. Carbamazepine - gold standard "tegretol" - 300-800mg dose daily split into 4 doses daily (dose is slowly increased) Side effects of Carbamazepine: drowsiness, tiredness, nausea, constipation, diploma + blurred vision, ataxia, rash allergy (e.g. Erythema Multiforme) (effective in reducing pain for ~70% pts, failure rx to increased severity of pain) 2. Oxcarbazepine (fewer side effects)
27
What is 2nd + 3rd tx for Trigeminal Neuralgia?
2nd = Lamotrigine (anticonvulsant) 3rd= Baclofen (antispasmodic i.e. muscle relaxant)
28
What is the final line/4th line tx for Trigeminal Neuralgia?
Posterior fossa surgery for microvascular decompression (good for long term relief, but risks of hearing loss, facial numbness, dizziness, post-op infection + stroke)
29
What is Burning Mouth Syndrome? (BMS)
Idiopathic burning discomfort or pain affecting people with clinically normal oral mucosa in whom a medical or dental cause has been excluded
30
What does the SOCRATES for Burning Mouth Syndrome look like?
Site- Tongue, lips palate Character- Burning, tender, tiresome feeling Radiation: Whole mouth Assoc factors: feeling of oral dryness, altered taste, depression, anxiety, F>60yrs Timing: continuous, intermittent, worse PM Relieving factors: rest, eating, distraction Provoking factors: eating, stress
31
What is the most common aetiology?
Hormonal i.e. women post menopause due to neuropathic + hormonal changes
32
What is the tx for Burning Mouth Syndrome?
Reassure pt it's not cancer and the symptoms have a psychological basis Exclude local or medical cause for symptoms Symptomatic management: - saliva substitutes, diluted benztdamine oral rinse - if low mood, refer to GP - low dose antidepressants, TCA (nortriptyline) or SSRI (flouxetine) - other meds: gabapentin, alpha lipoic acid (food supplement) - CBT
33
What is prognosis for Burning Mouth Syndrome?
Can affect pt for long time, even w/ tx
34
What is Persistent Idiopathic Pain?
= poorly localised pain w/ widespread radiation (hx of chromic dental pain w repeated unsuccessful dental interventions)
35
What are the initiating factors related to Persistent Idiopathic Facial Pain? (PIFP)
Dental interventions Severe Dental Infections Stress during major life event
36
What does SOCRATES for PIFP look like?
Site: unilateral, bilateral, no anatomical area, poorly localised Character: nagging, dull, throbbing, sharp, aching Radiation: head + neck, down arms Associations: IBS, head, neck + back ache, dysmenorrhea, itchiness, chronic fatigue, sleep disturbance, pain in other areas, rx life events Timing: intermittent or constant E/R: chewing, stress, cold weather, dental stress | rest, relaxation Severity: mild-severe
37
What is Atypical Ondontalgia?
- a sub-division of facial pain that is more localised - pain in a tooth or edent.alveolar ridge in which no clinical or radiological abnormal findings can be detected (>80% of pts relate onset of pain w/ initial dental tx)
38
What are the symptoms of Atypical Odontalgia?
- persistent intraoral pain - onset in conjunction w/ dental tx - often well localised - worse on chewing sometimes - assoc w/ any tooth or XLA site but pain may move from tooth to tooth - maxillary premolars + molars most commonly affected
39
What is the tx for Atypical Odontalgia?
- encouraging pt there is no dental cause - essential to stop ongoing cycle of dental tx/XLAs - topical lidocaine - low dose systemic TCA e.g. nortriptyline , amitriptyline) or gabapentin or pregabalin
40
What is Giant Cell Arthritis?
Granulomatous arthritis affecting medium/large size arteries (esp extra cranial branches of carotid arteries)
41
Who does Giant Cell Arthritis affect?
- Elderly pts (>50yrs) w/ new onset of headache or facial pain
42
What condition does Giant Cell Arthritis overlap with/? (differential)
Polymyalgia rheumatica (inflammatory condition affecting shoulders + muscles)
43
What are clinical features of Giant Cell Arthritis?
- can be silent - new onset or type of headache - temporal artery abnormality (tenderness or decreased pulse) i.e.when combing hair - Superficial temporal arteries thickened, nodular, tender, erythematous w/ reduced pulse - Ophthalmic blurring, diplopia (visual disturbances) - Discomfort of tongue, jaw + chewing - Rarely necrosis of tongue + trismus
44
What are the complications of Giant Cell Arthritis?
Ischaemic complications Irreversible visual loss High platelet count
45
What is the management for Giant Cell Arthritis? a) investigations
- Temporal artery biopsy histology
46
What is the management for Giant Cell Arthritis? b) Tx
Tx: -immediate: corticosteroids - 40-60mg prednisone/day - calcium + vitD supplements (improvement in a few days but visual loss only improves in a few pts)
47
What is the prognosis of Giant Cell Arthritis?
Risk of morbidity due to assoc/ cardiovascular disease
48
List 4 types of rarer headaches syndromes presenting w/ facial pain and autonomic features?
1. Cluster headache 2. Paroxysmal hemicranias 3. SUNCT (short-lasting unilateral neuralgiform w conjunctival infection + tearing) 4. SUNA (short-lasting unilateral autonomic headache) - hard to differentiate between these
49
Who is affected by rare headaches syndromes?
M>F Young (28-30yrs) At night typically
50
What is a cluster headache?
unilateral attacks of pain involving orbital, frontal + temporal regions
51
What are symptoms of Cluster Headaches?
- ocular involvement (conjunctival infection, small eye, ptosis, photophobia, ipsilateral lacrimation + rhinorhoea) - occurs >2xweek for greater than 1yr - restlessness - nausea + phonophobia - pain builds for 5-10mins + lasts for ~2hrs - onset 90mins before sleep - seasonal periodicity
52
What is the management for cluster headache?
- avoid alcohol (main trigger) Acute tx: -sumatriptan (subcutaneous injection) -zolmitriptan nasal spray - O2 7l/min Prophylaxis: Verapamil Lithium Corticosteroids

BDS5 Oral Med (12 decks)

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