Term
| the difference between acute and chronic? |
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Definition
acute pain: quick onset, can tell where it's at
chronic: 3-6 months lasting pain or longer, dull, hard to find, and hard to heal |
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Term
| Ther are 4 types of orofacial pain |
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Definition
Dentoalveolar pain: tooth, periodontal pulpal ,cracked tooth ,savlirary gland, oral mucosa, max sinus
Musculoskeletal: TMD
Neurovascular pain: primary headache, migraine, cluster headache, tension, temporal arteritis
Neuropathic pain:
episodic - trigeminal neuralgia, glossopharyngeal neuralgia
continuous - burning mouth pain |
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Term
| What kind of pain is temporomandibular disorder (TMD) |
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Definition
musculoskeletal oropathic pain
msucles affected; temporalis, medial, lateral pterygoids, masseter
what is the cause: non-dental pain
OPPERA (orofacial pain prospective evaluation and risk assessment) |
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Term
| what does the cohort studies say about the cause of TMD? |
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Definition
multifactorial/biopsychosocial causing TMD (multiple problem)
idiopathic causes:
1. stress
2. pain amplification (injury,BP, impaired0
3. oral parafx, self-report tmd noise, morbid condition (systemic healht), palpation sites and pain in amsseter. |
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Term
| what are the 4 categories of causing TMJ? |
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Definition
a. TMD
- joint pain - arthralgia similar to athritis
- joint disorder (disc, hypermobility)
- joint disease (degenerative joint, athritides, idiopathic condylar)
- fractures
- congenital developmental disorder
b. masticatory muscle disorder> muscle pain
c. headache
d. associated structure> coronoid hyperplasia |
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Term
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Definition
inspect Muscle: myositis, myospasm, myalgia (local, or myofascial and referral?)
joint: itnernal dernage via disc displacement without reduction, arthralgia, stereoarthritis, degenerative joint disease, hypermobility disorder, hypomobility, adjesion, ankylosis, subluxation, dislocation |
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Term
| Clinical symptoms of tmd: |
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Definition
facial pain in TMD
facial pain > muscles
mandibular movement limited
TMJ sounds> headache, ear pain, tinnitus |
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Term
| what are some muscle pain of tmd? |
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Definition
myofascial pain: dull, aching pain, trusmus
Trigger? hypersensitive palpable nodular mass of tendon/ligament/tautband skeletal muscle
Referral pain (non-odontogenic toothache)
cheek lower jaw, ear, forehead, temporal) |
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Term
| what are joint diseases that affect tmj? |
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Definition
Internal derangement includes:
a. disc displacement with reduction: click, deviation from opening pattern, soft tissue, no resection in ROM
> tx reduction of joint
b. Disc displacement without reduction (closed lock)
-hx sudden limited opening
- pain on opening
> deviation on one side of opening
> limited excursion on contralateral side
need MRI
c. Arthralgia from synovitis/capsulitis)
- localized TMJ pain from self report/exam)
d. Osteoarthritis/Degenerative joint disease:
- NKC< middle age, joint pain ,crepitus
dx: pano/ct > bird beak on joint is osteoarthritis/degenerative joint disease |
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Term
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Definition
palpaltion
TMJ evalualation: ROM > open, protrusive, excursive movements
joint sound/crepitus, joint palpation
image: pano/cbct, MRI |
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Term
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Definition
conservative, reversible, evidence therapueitc modalities.
no specific therapies proven to be effective
consevative modalities: providng symptomatic relief only
least invasive as possible:
decrease pain, increase ROM, Increase quality of life
educate the patient, splint, drugs ,physical therapy, cognitive behavioral intervention
surgery as resort |
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Term
| What are episodic neuropathic pain? |
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Definition
| trigeminal neuralgia, glossopharyngeal neuralgia |
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Term
| Trigeminal neuralgia/tic douloureux |
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Definition
vascular compression of trigeminal nerve due to
1. malformation of vascular
2. trauma/tumor/demyelinating
nerve affected: V2/V3
age: elderly
pain: paroxysmal pain/electric shock mancinating pain, that can cause toothache, then no pain (refractory period) then pain again
neuro examination: normal
Tx: carbamazepine/tegretol 100mg bid titrate for max 1200/day, monitor CBC and paltelet
if you're asian: screen ofr HLAB 1502 alelle before using carbamazepine/tegretol
sx: rhizotomy, glycerol rhizotomy, baloon compression, microvasuclar decompression
gamma knife surgery (sterotactic radiosurgery) |
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Term
| Glossopharyngeal neuralgia: |
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Definition
stabbing/burning pain that happens on unilateral side of tongue
Trigger: swallowing, chewing, yawning, talking
pain: ear, base of tongue, tonsillar fossa, beneath angle of mandible |
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Term
| Bell palsy (idiopathic facial paralysis) |
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Definition
acute weakness/paralysis of facial nerve with no known cause, but can be related to
1. herpes relations (HSV or varciella zoster)
2. cell mediated autoimmune rxn
age: young, very sudden onset
muscle control loss unilaterally (opposite side of nerve)
tx: self-limit, recovery resolves itself in 3-4 months...
steroid, antiviral therapy |
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Term
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Definition
shingle infection, affecting facial nerve
clinic: red rash fluid filled blisters around one ear. see facial wekaness, paralysis on same side as affected
ex: what dad got
tx :acyclovir, antivrial meds and corticosteroid |
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Term
| Melkersson rosenthal syndrome |
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Definition
fissured tongue, upper lip swell, recurrent facial paralysis
NSAIDS/corticosteroids |
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Term
| Frey syndrome/auriculotemporal syndrome |
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Definition
facial flush, sweat along auriculotemporal nerve, pain during chewing
complications of surgery:
> location: pre-auricular and temporal area
tx: botox injection, anticholinergic medication |
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Term
| Giant cell arteritis (temporal arteritis) |
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Definition
immune mediated arteritis (attacks artery) causing superficial temporal artery (common site) inflammation
HLA-Dr4 genetic disposition
older 70 yars old female with headache, scalp tenderness, jaw claudication (cramping pain, masster, temporal increases with fx movements)
dx: erythrocyte sedimentation, C-reactive protein biopsy of temporal artery
tx: systemic steroid |
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Term
| Continuous neuropathic pain - burning mouth syndrome |
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Definition
chronic burning pain in mouth from nosological entity: all pain (sting, burn, absence of specific oral lesions) without alteration in blood.
two methods of BMS
a. primary/idiopathic BMS
b. secondary BMS to
- dry mouth ,candidasis, allergies (denture amteiral )nutritional deficiecy like Fe, B6, b12, folic), oral habit, tongue thrust, brux, GERD, hormonal imbalance (menopausal), anxiety and depression ,cranial nerve injury
feamle often cause of menopausal age... however doesn't interfere with sleep
TOngue is the most common location for thi pain
PRimary idiopatic bms: alpha lipoic acid/clonazepam |
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