Orofacial pain can be somatic, neuropathic, or psychogenic in origin. Somatic pain results from stimuli affecting structures like teeth, skin or bone and is usually acute and localized. Neuropathic pain is abnormal nerve pain that may be paroxysmal or continuous, as seen in trigeminal neuralgia. Psychogenic pain has no physical cause and is characterized as diffuse, chronic pain that worsens with stress. Common causes of orofacial pain include dental diseases, sinusitis, temporomandibular joint disorders, and neurological conditions like trigeminal neuralgia.
This document discusses the evaluation, classification, causes and treatment of orofacial pain. It defines orofacial pain as unpleasant sensation caused by noxious stimuli along nerve pathways to the central nervous system. The evaluation of orofacial pain patients involves medical history, pain characteristics, physical exam and diagnostic tests. Pain is classified as somatic, neurogenic or psychogenic based on origin. Common causes include local dental issues, neurological conditions like trigeminal neuralgia, and psychogenic factors. Treatment depends on diagnosis but may include medications, nerve blocks or surgery.
This document discusses various types of orofacial pain, their causes, symptoms, diagnosis, and treatment. It covers conditions like trigeminal neuralgia, glossopharyngeal neuralgia, postherpetic neuralgia, Eagle's syndrome, temporomandibular pain, burning mouth syndrome, atypical facial pain, migraine, cluster headache, and temporal arteritis. For each condition, it provides details on definition, etiology, clinical features, diagnostic approach, and management options. The take home message is that orofacial pains are a common cause of morbidity, definitive diagnosis can be challenging, and treatments may not always be definitive.
Pain is an unpleasant sensory experience associated with actual or potential tissue damage. Facial pain can originate from various structures innervated by cranial nerves like the trigeminal nerve. It can be nociceptive, neuropathic, inflammatory, acute, chronic, or referred pain from other sources. A thorough history, exam of the head and neck, and diagnostic tests are needed to diagnose the underlying cause. Common conditions include dental issues, TMJ disorders, trigeminal neuralgia, post-herpetic neuralgia, migraine, cluster headaches, and psychogenic or idiopathic facial pain syndromes. Careful diagnosis is important to guide appropriate treatment.
Orofacial pain is the field of dentistry devoted to the diagnosis and management of complex facial pain and oro motor disorder
Orofacial pain is the term covering any pain in the mouth , Jaw and face
1. The document discusses various types of orofacial pain including somatic, neurogenic, and psychogenic pain. It describes trigeminal neuralgia as a common type of neurogenic pain characterized by sharp, electric shock-like pain in the face that is triggered by stimulation of specific trigger zones. 2. Evaluation of orofacial pain involves taking a thorough medical history and performing physical and neurological examinations. Differential diagnosis considers local causes as well as neurological disorders. 3. Treatment depends on the underlying cause but may include medications, nerve blocks, surgery, or a combination. Carbamazepine is first-line treatment for trigeminal neuralgia.
an overview of muscle pain disorder which regularly create some discomfort for patient to live a normal life as well as to the doctor regarding diagnosis of the problem.
Atypical facial pain describes a type of chronic dull pain that may affect one or both sides of the face and is not associated with nerve distributions. It has no clear underlying cause. Management involves eliminating potential systemic or local causes, counseling, and cognitive behavioral therapy or antidepressant therapy to address pain beliefs and anxiety. Cognitive behavioral therapy aims to help patients restructure thoughts about their pain and change avoidance behaviors through relaxation, distraction, and activity.
Orofacial pain can be somatic, neuropathic, or psychogenic in origin. Somatic pain results from stimuli affecting structures like teeth, skin or bone and is usually acute and localized. Neuropathic pain is abnormal nerve pain that may be paroxysmal or continuous, as seen in trigeminal neuralgia. Psychogenic pain has no physical cause and is characterized as diffuse, chronic pain that worsens with stress. Common causes of orofacial pain include dental diseases, sinusitis, temporomandibular joint disorders, and neurological conditions like trigeminal neuralgia.
This document discusses the evaluation, classification, causes and treatment of orofacial pain. It defines orofacial pain as unpleasant sensation caused by noxious stimuli along nerve pathways to the central nervous system. The evaluation of orofacial pain patients involves medical history, pain characteristics, physical exam and diagnostic tests. Pain is classified as somatic, neurogenic or psychogenic based on origin. Common causes include local dental issues, neurological conditions like trigeminal neuralgia, and psychogenic factors. Treatment depends on diagnosis but may include medications, nerve blocks or surgery.
This document discusses various types of orofacial pain, their causes, symptoms, diagnosis, and treatment. It covers conditions like trigeminal neuralgia, glossopharyngeal neuralgia, postherpetic neuralgia, Eagle's syndrome, temporomandibular pain, burning mouth syndrome, atypical facial pain, migraine, cluster headache, and temporal arteritis. For each condition, it provides details on definition, etiology, clinical features, diagnostic approach, and management options. The take home message is that orofacial pains are a common cause of morbidity, definitive diagnosis can be challenging, and treatments may not always be definitive.
Pain is an unpleasant sensory experience associated with actual or potential tissue damage. Facial pain can originate from various structures innervated by cranial nerves like the trigeminal nerve. It can be nociceptive, neuropathic, inflammatory, acute, chronic, or referred pain from other sources. A thorough history, exam of the head and neck, and diagnostic tests are needed to diagnose the underlying cause. Common conditions include dental issues, TMJ disorders, trigeminal neuralgia, post-herpetic neuralgia, migraine, cluster headaches, and psychogenic or idiopathic facial pain syndromes. Careful diagnosis is important to guide appropriate treatment.
Orofacial pain is the field of dentistry devoted to the diagnosis and management of complex facial pain and oro motor disorder
Orofacial pain is the term covering any pain in the mouth , Jaw and face
1. The document discusses various types of orofacial pain including somatic, neurogenic, and psychogenic pain. It describes trigeminal neuralgia as a common type of neurogenic pain characterized by sharp, electric shock-like pain in the face that is triggered by stimulation of specific trigger zones. 2. Evaluation of orofacial pain involves taking a thorough medical history and performing physical and neurological examinations. Differential diagnosis considers local causes as well as neurological disorders. 3. Treatment depends on the underlying cause but may include medications, nerve blocks, surgery, or a combination. Carbamazepine is first-line treatment for trigeminal neuralgia.
an overview of muscle pain disorder which regularly create some discomfort for patient to live a normal life as well as to the doctor regarding diagnosis of the problem.
Atypical facial pain describes a type of chronic dull pain that may affect one or both sides of the face and is not associated with nerve distributions. It has no clear underlying cause. Management involves eliminating potential systemic or local causes, counseling, and cognitive behavioral therapy or antidepressant therapy to address pain beliefs and anxiety. Cognitive behavioral therapy aims to help patients restructure thoughts about their pain and change avoidance behaviors through relaxation, distraction, and activity.
Differential diagnosis of orofacial painsailesh kumar
Differential diagnosis of orofacial pain can be divided into acute and chronic categories. Acute pain includes dental, periodontal, sinus, and salivary gland issues and is usually inflammatory in origin. Chronic pain includes myofascial pain, TMJ disorders, migraines, and various neuropathies. Neuropathic pain includes trigeminal neuralgia, postherpetic neuralgia, glossopharyngeal neuralgia, and complex regional pain syndrome. Management depends on the underlying cause and includes medications, physical therapy, and occasionally surgery.
Atypical facial pain is a chronic facial discomfort or pain of unknown cause that typically affects middle-aged or older women. It is characterized by a dull, burning pain of ill-defined location with no objective signs or positive test results. The pathogenesis is unclear but may involve extreme stress, enhanced cerebral activity, and cell damage. Diagnosis involves ruling out other conditions through medical history, examination, and negative imaging and blood tests. Treatment can be challenging as the condition often does not respond well to interventions.
This document discusses orofacial pain and neuralgias. It defines pain and states that approximately 40% of the British population only visit dentists for pain relief. It then lists and describes various types of orofacial pain including those related to dental issues, jaw diseases, edentulism, postoperative issues, pain triggered by chewing, neurological diseases like trigeminal neuralgia, and atypical facial pain. It provides details on diagnosing and treating specific conditions like trigeminal neuralgia and Bell's palsy.
Local anesthesia causes loss of sensation in a specific body area by depressing nerve excitation or inhibiting nerve conduction without loss of consciousness. Local anesthetics work by altering the nerve membrane's resting potential, threshold potential, rate of depolarization, or rate of repolarization. They may act at receptor sites on the membrane surfaces or through physicochemical mechanisms. Anesthetics first block sensation in mantle nerve bundles near the surface before reaching deeper core bundles, potentially explaining inadequate pulpal anesthesia with profound soft tissue effects. Reinjection can provide immediate profound anesthesia but risks tachyphylaxis.
Myofascial pain syndrome is a pain disorder caused by trigger points in the muscles of the head and neck that refer pain to other areas. It is commonly caused by repetitive motions or stress-related muscle tension. Physical examination involves evaluating the muscles, joints, dental structures and cervical spine through range of motion tests, palpation, and sometimes imaging. Treatment includes medications like NSAIDs, trigger point injections, physical therapy techniques like heat, massage and exercises.
Orofacial pain can be classified into seven main categories: musculoskeletal, neuropathic, vascular, neurovascular, idiopathic, psychogenic, and pain caused by local, distant, or systemic pathology. Musculoskeletal orofacial pain includes temporomandibular disorders such as myofascial pain, myositis, myospasm, disc displacements, synovitis/capsulitis, osteoarthritis, and tension-type headaches. These pain types are evaluated through patient history, physical examination, and diagnostic imaging, and treated through elimination of triggers, physical therapy, medications, and stabilization appliances.
burning mouth syndrome oral medicine
defined as burning, painful or itching sensation located in oral mucosa, the tongue is most affected part, followed by lips and palate.
BMS may be subclassifid into
“primary”
or idiopathic BMS for which a neuropathological cause is likely and cannot be attributed to any systemic or local cause
“secondary Oral and perioral burning sensation as a result of local or systemic factors or diseases is classifid as SBMS
Other names:
glossodynia, glossopyrosis, stomatodynia, stomatopyrosis, sore tongue and oral dysaesthesia
The document discusses 4 main causes of hard tooth tissue reduction: attrition from tooth contact during chewing, abrasion from external agents like toothbrushing, erosion from acidic foods/drinks, and abfraction from occlusal stresses that cause flexing and cracks in tooth structure away from the contact point. Each cause is defined and the clinical presentations are described, including locations commonly affected and distinguishing features like sharp edges for abrasions or wedge-shaped defects for abfraction. References are provided.
oro-facial pain (other than neuralgias)Mammootty Ik
This document provides an overview of orofacial pain (OFP), including definitions, classifications, neural pathways, evaluation of patients, and treatment principles. OFP can be caused by diseases of the orofacial structures, musculoskeletal diseases, psychological factors, or referred pain from other sources. Evaluation of a patient with OFP involves taking a thorough history and performing a physical exam, with imaging and diagnostic nerve blocks used as needed to determine the cause. Classification systems organize OFP into physical and psychological categories to guide diagnosis and interdisciplinary treatment.
This document discusses pain in the orofacial region. It begins by defining pain and listing the cranial nerves involved in orofacial sensation. It then categorizes orofacial pain into local, neurological, vascular, psychogenic, and referred pain. For each type, it provides examples and brief descriptions. The document outlines the history and examination process for orofacial pain patients. It also discusses various pain measurement methods and diagnostic imaging/tests. Specific pain conditions are then described in more detail, including their symptoms, causes, and treatment options.
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
’s abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
The document discusses various types of oral pain such as those resulting from dental diseases like pulpitis or cysts, neurological diseases like Bell's palsy, and referred pain from other parts of the body. It provides details on the signs and symptoms, diagnostic features, and treatment of specific conditions. Additionally, it examines the relationship between anxiety and pain, the reasons for feeling pain, and the physiological mechanisms underlying the experience of pain.
MPDS, or myofascial pain disorder syndrome, is a pain disorder characterized by unilateral pain referred from trigger points in muscles of the head and neck. These trigger points are localized tender areas within taut muscle bands caused by micro- or macro-trauma to the musculoskeletal system. Accumulation of chemicals like lactic acid and prostaglandins in the muscles lowers the pain threshold, leading to MPDS symptoms like pain, limited jaw motion, and joint noises. Diagnosis involves assessing range of motion, palpating muscles for tenderness, and grading joint clicks. Treatment aims to inactivate trigger points, prevent recurrence, and correct perpetuating factors through therapies like physical modalities, anesthesia, pharmacotherapy, and occasionally
brief description on posterior superior alveolar nerve block.
its uses in dentistry, technique and action. locating PSA nerve is easy and this is the most used nerve block in dentistry.
Fissural cysts arise along lines of fusion between embryonic processes. Nasopalatine duct cysts are the most common non-odontogenic cyst, arising from epithelial remnants of the nasopalatine duct. Median palatal cysts occur in the midline of the hard palate from entrapped epithelium. Dermoid and epidermoid cysts contain skin elements and arise from implantation of epithelium during embryonic development. These cysts are examined clinically and radiographically and often surgically removed.
approach to swelling in maxillofacial regiondr.nikil נαιη
This document provides an overview of examining swellings in the head and neck region. It discusses taking a thorough history including duration and characteristics of the swelling. The physical examination involves inspection, palpation, percussion, and auscultation of the swelling and surrounding areas. Specific swellings are discussed based on their location in the orofacial region, salivary glands, lymph nodes and cervical region. Common etiologies including cysts, infections, benign and malignant tumors are highlighted. Radiographic imaging and laboratory investigations may be used to aid in diagnosis.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses the anatomy and histopathology of the periodontium, which consists of cementum, periodontal ligament, and alveolar bone. It describes the different types of cementum and cells found in the periodontal ligament. Chronic periapical lesions are discussed, including their etiology, clinical features, classifications, and examples such as chronic apical periodontitis and periapical granuloma. Treatment options are mentioned for various pathological conditions like symptomatic apical periodontitis.
The document discusses temporomandibular joint (TMJ) disorders, including TMJ dysfunction syndrome (TMD) and myofacial pain dysfunction syndrome (MPDS). It covers the anatomy of the TMJ, functional movements, classification of disorders, signs and symptoms, examination techniques, treatment options including reversible therapies like splint therapy and irreversible surgical treatment, and prevention strategies.
Burning Mouth Syndrome (BMS) is characterized by a burning sensation in the mouth without any clinically detectable cause. Women are affected more than men, especially post-menopausal women. The cause is unknown but may involve hormonal, salivary, psychiatric or neurological factors. Symptoms include burning of the tongue, lips or palate. Treatment focuses on reassurance and may include low dose tricyclic antidepressants, alpha-lipoic acid or capsaicin to reduce pain.
Toothaches are caused by issues like dental caries, cracks, injuries, or gum disease. A toothache feels like a sharp or dull pain in or around a tooth and it may be sensitive to temperature, pressure, or sweets. Seeing a dentist right away is important to diagnose and treat the underlying cause. The dentist will examine the mouth to identify the problem tooth and determine if infection or damage is present. Treatment depends on the cause but may include fillings, root canals, extractions, or antibiotics to address infection. Proper oral hygiene and regular dental visits can help prevent toothaches.
The document discusses oro-facial pain and its management. It describes various types of dental pain, including short, sharp shooting pain which can be caused by conditions that expose dentin like caries, fractures, or gum recession. Tests that can help diagnose dental pain are discussed, like pulp sensitivity tests, percussion, probing, mobility and palpation. Radiographs may also reveal issues like recurrent decay or bone loss. The goal of acute pain management is to inhibit tissue damage signaling, block nerve impulses, and activate endogenous analgesia.
Differential diagnosis of orofacial painsailesh kumar
Differential diagnosis of orofacial pain can be divided into acute and chronic categories. Acute pain includes dental, periodontal, sinus, and salivary gland issues and is usually inflammatory in origin. Chronic pain includes myofascial pain, TMJ disorders, migraines, and various neuropathies. Neuropathic pain includes trigeminal neuralgia, postherpetic neuralgia, glossopharyngeal neuralgia, and complex regional pain syndrome. Management depends on the underlying cause and includes medications, physical therapy, and occasionally surgery.
Atypical facial pain is a chronic facial discomfort or pain of unknown cause that typically affects middle-aged or older women. It is characterized by a dull, burning pain of ill-defined location with no objective signs or positive test results. The pathogenesis is unclear but may involve extreme stress, enhanced cerebral activity, and cell damage. Diagnosis involves ruling out other conditions through medical history, examination, and negative imaging and blood tests. Treatment can be challenging as the condition often does not respond well to interventions.
This document discusses orofacial pain and neuralgias. It defines pain and states that approximately 40% of the British population only visit dentists for pain relief. It then lists and describes various types of orofacial pain including those related to dental issues, jaw diseases, edentulism, postoperative issues, pain triggered by chewing, neurological diseases like trigeminal neuralgia, and atypical facial pain. It provides details on diagnosing and treating specific conditions like trigeminal neuralgia and Bell's palsy.
Local anesthesia causes loss of sensation in a specific body area by depressing nerve excitation or inhibiting nerve conduction without loss of consciousness. Local anesthetics work by altering the nerve membrane's resting potential, threshold potential, rate of depolarization, or rate of repolarization. They may act at receptor sites on the membrane surfaces or through physicochemical mechanisms. Anesthetics first block sensation in mantle nerve bundles near the surface before reaching deeper core bundles, potentially explaining inadequate pulpal anesthesia with profound soft tissue effects. Reinjection can provide immediate profound anesthesia but risks tachyphylaxis.
Myofascial pain syndrome is a pain disorder caused by trigger points in the muscles of the head and neck that refer pain to other areas. It is commonly caused by repetitive motions or stress-related muscle tension. Physical examination involves evaluating the muscles, joints, dental structures and cervical spine through range of motion tests, palpation, and sometimes imaging. Treatment includes medications like NSAIDs, trigger point injections, physical therapy techniques like heat, massage and exercises.
Orofacial pain can be classified into seven main categories: musculoskeletal, neuropathic, vascular, neurovascular, idiopathic, psychogenic, and pain caused by local, distant, or systemic pathology. Musculoskeletal orofacial pain includes temporomandibular disorders such as myofascial pain, myositis, myospasm, disc displacements, synovitis/capsulitis, osteoarthritis, and tension-type headaches. These pain types are evaluated through patient history, physical examination, and diagnostic imaging, and treated through elimination of triggers, physical therapy, medications, and stabilization appliances.
burning mouth syndrome oral medicine
defined as burning, painful or itching sensation located in oral mucosa, the tongue is most affected part, followed by lips and palate.
BMS may be subclassifid into
“primary”
or idiopathic BMS for which a neuropathological cause is likely and cannot be attributed to any systemic or local cause
“secondary Oral and perioral burning sensation as a result of local or systemic factors or diseases is classifid as SBMS
Other names:
glossodynia, glossopyrosis, stomatodynia, stomatopyrosis, sore tongue and oral dysaesthesia
The document discusses 4 main causes of hard tooth tissue reduction: attrition from tooth contact during chewing, abrasion from external agents like toothbrushing, erosion from acidic foods/drinks, and abfraction from occlusal stresses that cause flexing and cracks in tooth structure away from the contact point. Each cause is defined and the clinical presentations are described, including locations commonly affected and distinguishing features like sharp edges for abrasions or wedge-shaped defects for abfraction. References are provided.
oro-facial pain (other than neuralgias)Mammootty Ik
This document provides an overview of orofacial pain (OFP), including definitions, classifications, neural pathways, evaluation of patients, and treatment principles. OFP can be caused by diseases of the orofacial structures, musculoskeletal diseases, psychological factors, or referred pain from other sources. Evaluation of a patient with OFP involves taking a thorough history and performing a physical exam, with imaging and diagnostic nerve blocks used as needed to determine the cause. Classification systems organize OFP into physical and psychological categories to guide diagnosis and interdisciplinary treatment.
This document discusses pain in the orofacial region. It begins by defining pain and listing the cranial nerves involved in orofacial sensation. It then categorizes orofacial pain into local, neurological, vascular, psychogenic, and referred pain. For each type, it provides examples and brief descriptions. The document outlines the history and examination process for orofacial pain patients. It also discusses various pain measurement methods and diagnostic imaging/tests. Specific pain conditions are then described in more detail, including their symptoms, causes, and treatment options.
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
’s abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
The document discusses various types of oral pain such as those resulting from dental diseases like pulpitis or cysts, neurological diseases like Bell's palsy, and referred pain from other parts of the body. It provides details on the signs and symptoms, diagnostic features, and treatment of specific conditions. Additionally, it examines the relationship between anxiety and pain, the reasons for feeling pain, and the physiological mechanisms underlying the experience of pain.
MPDS, or myofascial pain disorder syndrome, is a pain disorder characterized by unilateral pain referred from trigger points in muscles of the head and neck. These trigger points are localized tender areas within taut muscle bands caused by micro- or macro-trauma to the musculoskeletal system. Accumulation of chemicals like lactic acid and prostaglandins in the muscles lowers the pain threshold, leading to MPDS symptoms like pain, limited jaw motion, and joint noises. Diagnosis involves assessing range of motion, palpating muscles for tenderness, and grading joint clicks. Treatment aims to inactivate trigger points, prevent recurrence, and correct perpetuating factors through therapies like physical modalities, anesthesia, pharmacotherapy, and occasionally
brief description on posterior superior alveolar nerve block.
its uses in dentistry, technique and action. locating PSA nerve is easy and this is the most used nerve block in dentistry.
Fissural cysts arise along lines of fusion between embryonic processes. Nasopalatine duct cysts are the most common non-odontogenic cyst, arising from epithelial remnants of the nasopalatine duct. Median palatal cysts occur in the midline of the hard palate from entrapped epithelium. Dermoid and epidermoid cysts contain skin elements and arise from implantation of epithelium during embryonic development. These cysts are examined clinically and radiographically and often surgically removed.
approach to swelling in maxillofacial regiondr.nikil נαιη
This document provides an overview of examining swellings in the head and neck region. It discusses taking a thorough history including duration and characteristics of the swelling. The physical examination involves inspection, palpation, percussion, and auscultation of the swelling and surrounding areas. Specific swellings are discussed based on their location in the orofacial region, salivary glands, lymph nodes and cervical region. Common etiologies including cysts, infections, benign and malignant tumors are highlighted. Radiographic imaging and laboratory investigations may be used to aid in diagnosis.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses the anatomy and histopathology of the periodontium, which consists of cementum, periodontal ligament, and alveolar bone. It describes the different types of cementum and cells found in the periodontal ligament. Chronic periapical lesions are discussed, including their etiology, clinical features, classifications, and examples such as chronic apical periodontitis and periapical granuloma. Treatment options are mentioned for various pathological conditions like symptomatic apical periodontitis.
The document discusses temporomandibular joint (TMJ) disorders, including TMJ dysfunction syndrome (TMD) and myofacial pain dysfunction syndrome (MPDS). It covers the anatomy of the TMJ, functional movements, classification of disorders, signs and symptoms, examination techniques, treatment options including reversible therapies like splint therapy and irreversible surgical treatment, and prevention strategies.
Burning Mouth Syndrome (BMS) is characterized by a burning sensation in the mouth without any clinically detectable cause. Women are affected more than men, especially post-menopausal women. The cause is unknown but may involve hormonal, salivary, psychiatric or neurological factors. Symptoms include burning of the tongue, lips or palate. Treatment focuses on reassurance and may include low dose tricyclic antidepressants, alpha-lipoic acid or capsaicin to reduce pain.
Toothaches are caused by issues like dental caries, cracks, injuries, or gum disease. A toothache feels like a sharp or dull pain in or around a tooth and it may be sensitive to temperature, pressure, or sweets. Seeing a dentist right away is important to diagnose and treat the underlying cause. The dentist will examine the mouth to identify the problem tooth and determine if infection or damage is present. Treatment depends on the cause but may include fillings, root canals, extractions, or antibiotics to address infection. Proper oral hygiene and regular dental visits can help prevent toothaches.
The document discusses oro-facial pain and its management. It describes various types of dental pain, including short, sharp shooting pain which can be caused by conditions that expose dentin like caries, fractures, or gum recession. Tests that can help diagnose dental pain are discussed, like pulp sensitivity tests, percussion, probing, mobility and palpation. Radiographs may also reveal issues like recurrent decay or bone loss. The goal of acute pain management is to inhibit tissue damage signaling, block nerve impulses, and activate endogenous analgesia.
The document discusses diseases of the dental pulp, including pulpitis and necrosis. It defines the pulp as the formative organ of the tooth that builds dentin. Pulpitis is the most common cause of dental pain and can be reversible or irreversible depending on the severity of inflammation. Untreated pulpitis can lead to necrosis or death of the pulp. Causes include mechanical, thermal, chemical, and bacterial factors. Management involves removal of irritants and root canal treatment if needed.
(1) Head and neck swellings can have many causes, including lymph node enlargement, cysts, infections, benign and malignant tumors. (2) While some masses are cancerous, many are non-cancerous cysts or enlarged lymph nodes. (3) Evaluation of persistent or enlarging lumps involves medical history, physical exam, and may include imaging tests and biopsy to determine if surgical removal or other treatment is needed.
This document provides an overview of pain and pain pathways. It defines pain, discusses the history of pain theories, and describes the different types of pain receptors and neural pathways involved in pain perception and modulation. Specifically, it outlines fast and slow pain pathways conducted by myelinated and unmyelinated fibers, discusses peripheral and central mechanisms of injury-induced pain, and classification of pain including somatic and visceral pain.
This document provides information on assessing and diagnosing various types of orofacial pain, including dental pain, dentine sensitivity, pulpitis, abscess, pericoronitis, dry socket, trigeminal neuralgia, preherpetic neuralgia, and atypical odontalgia. It describes the nature, symptoms, causes, diagnosis, and management of each condition. Key factors assessed include the location, duration, and triggers of the pain, as well as relevant medical and dental history. Diagnosis involves clinical examination, vitality testing, percussion, and radiography to determine the specific cause and appropriate treatment.
Orofacial pain and altered sensation Lecture1Ishfaq Ahmad
This document discusses orofacial pain and its diagnosis. It describes how pain is transmitted through pathways in the body and classified the main types of orofacial pain as being of dental origin, non-dental origin, or psychogenic origin. It provides details on diagnosing pain based on factors like site, onset, character, radiation, exacerbating factors and severity. Common causes of dental pain include pulpal pain, periodontal pain and bone pain, while non-dental sources include neurological issues, vascular problems and disorders of the sinuses, salivary glands and more. Diagnosis relies heavily on understanding these diagnostic factors from the patient's history and description of their pain.
This document summarizes the pain pathway in the human body. It begins with an introduction to pain and its characteristics. It then discusses the different types of pain sensations conducted by different nerve fibers. It explains Gate Control Theory and the differences between somatic and visceral sensory function. It provides details on pain receptors, the pathway of sensory impulses from receptors to the brain, and examples of tooth pulp pain and referred pain. It concludes with management strategies for pain.
This document outlines various causes of pain that can originate in the oral cavity and face. It discusses pain originating from tissues like mucosa, teeth, sinuses and muscles. It also covers neurological conditions that can cause facial pain like trigeminal neuralgia or migraines. For each cause, it provides details on presentation, diagnostic factors and potential treatment approaches.
Facial pain is pain felt in any part of the face, including the mouth and eyes.
It’s normally due to an injury or a headache, occasionally facial pain may also be due to neurological or vascular causes, but equally well may be dental in origin.
Dr. Mohammed Rhael Ali discusses various types and causes of orofacial pain in a detailed document. He outlines somatic pain originating from cells in organs like skin, mucous membranes, bones and joints, as well as neurogenic pain resulting from abnormalities in the nervous system. Specific conditions covered include trigeminal neuralgia, migraine, temporomandibular joint disorders, and atypical facial pain. The document provides criteria for evaluating orofacial pain and classifications based on origin, in addition to diagnostic methods and treatment approaches for different pain conditions.
Facial neuropathology Maxillofacial SurgeryLama K Banna
Lecture 4 facial neuropathology
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
1) The document discusses the neurophysiology of pain, including what pain is, types of pain receptors and fibers, pathways in the spinal cord, and modulation of pain.
2) It describes fast pain and slow pain fibers, nociceptors that respond to noxious stimuli, and receptors like vanilloid receptor-1 and VRL-1 that detect harmful temperatures.
3) Pathways like the spinothalamic tract and paleospinothalamic tract transmit signals from nociceptors to the brain.
This document discusses pain pathways related to the orofacial region and periodontium. It describes how pain signals are transmitted from nociceptors through three orders of neurons to the brain. First order neurons carry signals from nociceptors to the spinal cord, second order neurons transmit signals to the thalamus, and third order neurons relay signals to the sensory cortex. The trigeminal nerve provides innervation and sensory function to the periodontium. Understanding pain pathways and sources is important for properly diagnosing and treating orofacial pain.
25 introduction and types of neuralgiasvasanramkumar
This document discusses various types of neuralgias, including primary and secondary neuralgias. Primary neuralgias include trigeminal neuralgia, glossopharyngeal neuralgia, and geniculate neuralgia. Trigeminal neuralgia causes sudden, severe facial pain and is the most common type of neuralgia. Secondary neuralgias are caused by identifiable lesions that can irritate nerves, with examples being tumors, multiple sclerosis, and herpes zoster infection. The document provides details on symptoms, causes, and treatments for different neuralgias.
The document discusses various topics related to pain, including definitions, types, causes, symptoms, investigations, and treatments. It defines pain and differentiates it from nociception. It describes acute and chronic pain, as well as types including malignant and non-malignant pain. Physiological pain origins like cutaneous, somatic, and visceral pain are explained. Common and serious causes of pain in different body regions are listed. Investigations and various allopathic and alternative pain treatment methods are also outlined.
Tetanus is caused by Clostridium tetani bacteria entering the body through wounds. It produces a toxin that causes painful muscle spasms. Symptoms include lockjaw, back arching, and muscle stiffness. Treatment focuses on wound cleaning, antibiotics, muscle relaxants, and preventing complications until the toxin dissipates. Tetanus can be fatal if not properly treated. Vaccination provides the best prevention against this infectious disease.
This document provides information about orofacial pain, including:
1. It classifies orofacial pains into somatic pain, musculoskeletal pain, neuropathic pain, and other conditions.
2. It describes how to clinically evaluate pain through taking a thorough patient history and looking for associated signs and symptoms.
3. It outlines typical orofacial pains like dental pain, periodontal pain, TMJ pain, and maxillary sinus pain, and how they present and are treated. It also covers psychogenic orofacial pains like facial arthromyalgia.
This document discusses diseases of the nerves, focusing on trigeminal neuralgia. It defines trigeminal neuralgia as a condition where stimulation of a trigger zone initiates sharp, stabbing pain along the distribution of the trigeminal nerve. It most commonly affects those over 50 years old and the right side of the face. While the exact cause is unknown, it often involves compression of the trigeminal nerve root by blood vessels. Treatment options include medications like carbamazepine or surgical procedures. Differential diagnosis considers conditions like sinusitis, migraines or dental issues that can cause similar pain patterns.
This document provides an overview of pain, including its definitions, classifications, mechanisms and management. It defines pain as an unpleasant sensory experience associated with actual or potential tissue damage. Pain is classified as acute, chronic, neuropathic, musculoskeletal and others, based on duration and source. The pathways involve nociceptors detecting pain, first order neurons in the dorsal root ganglion, second order neurons in the spinal cord projecting to the thalamus, and third order neurons projecting to the brain. Managing pain involves understanding its types, causes, receptors and pathways.
This document discusses various theories related to referred pain and pain perception from dental structures. It provides explanations for referred pain including dermatomal rule and convergence-projection theory. It also summarizes different theories for tooth pain perception such as dentinal nerve stimulation, dentinal receptor theory, and the popular hydrodynamic theory. Pulpal pain, periodontal pain, and other orofacial pain conditions are also briefly characterized.
The document discusses various types of orofacial pain including trigeminal neuralgia, post-herpetic neuralgia, atypical facial pain, and burning mouth syndrome. It covers the etiology, pathophysiology, clinical manifestations, diagnosis and management of each condition. Chronic pain is defined as pain persisting beyond tissue healing. Neuroplastic changes in the central nervous system are believed to underlie chronic pain. Treatment involves cognitive therapy, medications like anticonvulsants, antidepressants and opioids, as well as surgical options in some cases.
Symptomatology and pathophysiology of trigeminal neuralgia copypriyanka susruth
Trigeminal neuralgia is characterized by brief, severe, stabbing pains in the face that are often triggered by trivial stimuli. It is mostly caused by blood vessel compression of the trigeminal nerve root. Diagnosis involves unilateral facial pain in the trigeminal nerve distribution that is provoked by triggers. Treatment options include carbamazepine medication or microsurgical decompression/ablative surgeries if drugs fail.
Transverse myelitis is an inflammatory disorder of the spinal cord characterized by focal inflammation and clinical manifestations below the level of inflammation including pain, muscle weakness, sensory alterations, and autonomic dysfunction. It has various causes such as being part of multiple sclerosis or systemic lupus erythematosus, occurring post infection, or being idiopathic. Diagnosis involves MRI, lumbar puncture, neurological exam and differential diagnosis includes multiple sclerosis, disc lesions, NMO, and ADEM. Management consists of corticosteroids, plasmapheresis, immunosuppressants, and physiotherapy.
The document discusses root canal obturation and sealers. It describes the purpose of obturation as completely filling the root canal to prevent reinfection. The timing of obturation depends on factors like patient symptoms and pulp/periapical status. Obturation materials include gutta-percha, resilon, and various cements and pastes. Gutta-percha is the most commonly used material due to its biocompatibility and ability to adapt to canal shapes. Lateral and vertical compaction techniques are described for placing gutta-percha. Sealers are also needed to fill irregularities and provide a fluid-tight seal between gutta-percha and the canal walls. Common sealers include zinc
Minor oral surgery procedures include trans alveolar extractions and removing impacted teeth. Impacted teeth fail to erupt into the dental arch due to issues like lack of space, obstruction, or malpositioning. Impacted third molars can be difficult to remove depending on their position, depth, orientation, and root morphology. A thorough clinical and radiographic examination is needed to assess difficulty and plan the surgery appropriately. Complications are minimized by using proper surgical techniques like raising a mucoperiosteal flap to provide access and visibility while preserving the blood supply.
Oral manifestations of gastrointestinal disordersThilanka Umesh
This document discusses various oral manifestations of gastrointestinal disorders, including:
1. Gastroesophageal reflux disease, which can cause tooth erosion from stomach acid contact. Enamel is lost in a smooth, shiny pattern.
2. Crohn's disease and ulcerative colitis, which can cause oral ulcers and lesions related to nutritional deficiencies from inflammation and malabsorption.
3. Orofacial granulomatosis, characterized by non-caseating granulomatous inflammation affecting the lips and oral tissues, causing swelling. Corticosteroids are a first-line treatment but relapses are common.
Non-neoplastic salivary gland disorders can be congenital, inflammatory, infectious, endocrine/metabolic, autoimmune/benign lymphoepithelial lesions, or drug induced. Dry mouth (xerostomia) is caused by decreased saliva production or composition changes and can be iatrogenic (from medications), physiological (dehydration), or due to diseases like Sjogren's syndrome. Sjogren's syndrome is an autoimmune disorder affecting the salivary and lacrimal glands, causing dry eyes and dry mouth. It is characterized by lymphocytic infiltration of the glands and is associated with connective tissue diseases. Diagnosis involves evaluating symptoms, signs, and
1. The document discusses various causes and types of oral ulcers including recurrent aphthous ulcers, gastrointestinal causes like Crohn's disease and ulcerative colitis, and mucocutaneous conditions like oral lichen planus, pemphigus, and pemphigoid.
2. Recurrent aphthous ulcers are small round ulcers with erythematous halos that can be caused by genetic or nutritional deficiencies. Management involves correcting deficiencies and using mouthwashes or pastes.
3. Crohn's disease can cause oral ulcers and other manifestations. Ulcerative colitis rarely causes oral lesions but may result in chronic ulceration.
4. Mucoc
This document discusses oral pigmentation and classifies it as either endogenous or exogenous based on its origin. Endogenous pigmentation is produced by the body and includes hemoglobin, melanin, and hemosiderin, while exogenous pigmentation comes from outside sources like tobacco or vegetables. Various diseases can cause changes in color, texture, or vascularization of oral tissues. Blue, brown, and black pigmentation can be attributed to the deposition of endogenous or exogenous pigments. The document then examines specific conditions that cause blue/purple, brown, or gray/black pigmentation like hemangiomas, varices, Kaposi's sarcoma, and various nevi. It provides details on the features, causes, diagnoses
for undergraduate dental students this presentation includes essential & common disorders which related to the tongue very briefly. Though this may be very helpfull to you to as a start for further readings & studying.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
2. 1
Physiological basis for the pain
Definition for the pain by IASP
Pain is an unpleasant sensory or emotional experience associated with actual or potential
tissue damage, or describe in terms of such damage.
Nature of pain
Subjective Modified by the Cultural/ Behavioural/ Personality/ Developmental factors
Protective
It is a symptom
Associated with crying/ sweating/ BP/ HR increase
Having dual nature
Fast pain Slow pain
Acute
Pricking type
Short duration
Well localized
Thin myelinated A delta nerve fibers are
involved.
Chronic
Throbbing type pain
Poorly localized.
Long duration
Unmyelinated c nerve fibers are involved
Classification on the basis of pain
Nociceptive pain- Stimulation of the nociceptors due to
Chemical
Thermal
Mechanical events that has the potential to damage the body tissues.
Pain
Duration(Acute/ Subacute &
chronic)
Anatomy(Headache/
chest pain)
Mechanism
somatogenic (axis i)
Nociceptive
Superficial
Somatic
Deep
Somatic Visceral
Neuropathic
Episodic Continuous
psychogenic (Axis ii)
Quality(Sharp/
burning/ tight)
3. 2
Neuropathic pain- damage to the nerves system itself cause the neuropathic pain
Two types
- Peripheral neuropathic pain (Damge to the peripheral nerves)
- central neuropathic pain(Damage to the brain/ brain stem/ spinal cord)
Above two are mainly somatogenic pain, psychogenic pain is that caused, increased or
prolonged by Mental / Emotional/ Behavioural factors
Superficial somatic pain
1. Cutaneous pain
2. Mucogingival pain
Caused by mainly injury to skin or superficial tissues.
Cutaneous nociceptors terminates just below the skin & They are present in higher
concentrations so produse fast pain. Due to those reasons most of the time cutaneously minor
wounds & minor burns(1st
degree.) present,
No CNS excitatory effects.
LA at the site can abolish pain.
Deep somatic pain
1. Musculoskeletal pain
- Periodontal pain
- Osseous pain
- Muscular pain
- TMJ pain
- CT pain
Most of the time dull pain
Originates from ligaments, Tendons, Muscles, Bones, Blood
vessels & fascia.
Detected with somatic nociceptors, but due to the scarcity
of the pai receptors it causes dull, poorly localized pain on
longer duration than the cutaneous pain.
Eg- Broken bones/ Myofascial pain.
Pain response not always corresponds to the site &
intensity of the stimulus
CNs excitatory effects are common
Local anaesthetic block can eliminate the pain.
TMJ pain
Capsular pain(capsulitis)
Synovial pain (Synovitis)
Retrodiscal pain (Retrodiscitis)
Ligamentous pain
Arthritic pain
Muscular pain
Protective core contraction
Local muscle soreness
Myofascial pain
Myospasm
Centrally mediated myalgia
4. 3
Deep visceral pain
1. Pulpal pain
2. Vascular pain
3. Neuro vascular pain
4. Glandular pain
5. ENT pain
6. Occular pain
7. Visceral mucosal pain
Originate from body’s viscera, or organs. Visceral nociceptors are located within the body organs
& internal cavities.
The even greater scarcity of nociceptors in these areas produces pain that is usually more aching
or cramping & of a longer duration than somatic pain.
Visceral pain may be well localized, but often it is extremely difficult to localize, & several
injuries to visceral tissues exhibit “reffered” pain, where the sensation is localized to an area
completely unrelated to the site of injury.
Pain has no relationship for the biomechanical activity.
Pain does not arise until threshold of stimulus is attained.
process involved in nociception
1. Transduction – process of converting noxious stimuli to action potentials.
2. Perception – Central processing of nociceptive pain in order to interpret pain.
Stimuli – Chemicals/ electrical / Thermal/ physical
Neuropathic Pain
Spontaneous or triggered by non-noxious stimulus.
Does not corresponds to the intensity of the stimulus.
No evidence of tissue damage.
Episodic(Intermittent or paroxysmal
pain)
Continuous pain
Paroxysmal neuralgias
-Trigeminal neuralgias
-Glossopharyngeal neuralgias
- Geniculate neuralgia
- Superior laryngeal neuralgias
- Nervous intermedius neuralgia
Neurovascular pain(Overlaps to
some extent with deep visceral)
Centrally mediated
- Atypical odontalgia(Phantom pain)
- Post- herpetic neuralgia
- Burning mouth syndrome
- Chronic regional pain syndromes
Peripherally mediated
- Neuritic pain(Herpes zoster/ Peripheral Neuritis)
- Differentiation pain(Traumatic neuroma)
- Entrapment neuropathy
Sympathetically maintained pain
- Causalgia (pain arising on an operating site eg-
5. 4
after extraction )
- Reflex sympathetic dystrophy
Metabolic polyneuropathies
Rapid, Piercing, electric type of
pain
Incapacitating, very severe pain
Short duration
No pain between episodes
Pain occur in the distribution of
the concerned nerve
No evidence of tissue damage.
Dull, burning pain
Ongoing pain without remission
Intensity can vary
Additional neurological signs may be presents(Loss
of sensation, Paresthesia)
No evidence of tissue damage
Causes (Origin) of orofacial pain
1. Dental pain – Pain from dentine, pulp, periapical periodontal tissues, gingivae, lateral
periodontal tissues, tooth socket.
2. Pain arising from the mucosa(Labio buccal, lingual, floor of mouth & palate)
3. Pain arising from the jaw bone
4. Pain arising from temporomandibular joints & masticatory muscles.
5. Pain arising from the salivary glands & ducts
6. Pain arising from the maxillary & other sinuses.
7. Neuralgic pain- Neuropathic pain
8. Vascular pain – From cranio facial & blood vessels
9. Referred pain – Cervical spine, eyes, heart
10. Psychogenic pain- tension headache & other headaches, Atypical facial pain, Burning mouth
syndrome, Atypical odontalgia.
Dental pain
Exposure of Dentine
-Dentinal caries
-Fracture of tooth
-Cracked tooth syndrome
-Attrition of tooth
-Abrasion/ Erosion
Pulpitis
Apical periodontitis & Apical abscess
Periodontal abscess
ANUG
Desquamative gingivitis
Pericoronitis
Alveolar osteitis(Dry socket)
6. 5
Mucosal pain
Traumatic ulcers
Apthous ulcers
Erythema migrans(Tongue)
Foliate papilitis (Tongue)
Oral LP
Oral submucous fibrosis
DLE
Erythema multiforme
Malignancy
Radiation induced mucositis
Neuralgic pain
1. Trigeminal neuralgia
2. Glossopharyngeal neuralgia
3. Post-herpatic neuralgia
Pain arising from maxillary & other sinuses
1. Acute maxillary sinusitis
2. Frontal sinusitis
3. Ethmoidal sinusitis
4. Chronic maxillary sinusitis
Pain from jaw bones
1. Fracture of the jaw(Mandible/ zygoma/
Maxilla)
2. Osteomyelitis of mandible
3. Osteoradionecrosis
4. Bisphosphonate induced osteonecrosis
Pain arising from the salivary glands
1. Not all pathologies if salivary glands
cause pain.
2. Acute parotitis including recurrent
juvenile parotitis.
3. Mumps
4. Submandibular sialadenitis
5. Sialolithiasis
6. Sialodochitis(Infection of the duct)
Vascular pain
1. Migraine
2. Migranous neuralgia
3. Temporal(cranial arteritis)
Headaches
1. Tension headache
2. Other headache
Management of Orofacial pain
Mx of Dental pain
Mucosal pain is on other notes
Differential diagnosis from non-odontogenic
pain
1. TN
2. TMJ pain & pain of muscle origin
3. Maxillary sinusitis pain
4. Salivary gland pain
5. Migraine & migranous neuralgia
6. Glossopharyngeal neuralgia
7. Post herpetic neuralgia
8. Atypical odontalgia
9. Temporal arteritis
10. Oral dysaesthesia or burning pain in the
mouth.
11. Burning mouth syndrome
12. Atypical facial pain
TN
1. A characteristic neuropathic pain in the
distribution of one or more branches of
the fifth cranial nerve.
2. It occurs in paroxysms, with each
episode lasting from a few seconds to 2
minutes.
3. Frequency of paroxysms varies from
hundreds of attacks a day to long
period.
7. 6
Primary TN
TN Epidemiology Aetiology
Between successive episodes of
pain, the patient is pain free.
A severe pain that is intense,
sharp, superficial, stabbing,
shooting, incapacitating & often
like an electric shock.
In a single pts different attacks of
the pain have the same
character.
Pain provokes brief muscle spasm
of the facial muscles, thus
producing tic- patient grimaces
with contortion of the face.
Light touch in a specific area or
talking, washing the face or
brushing the teeth may trigger an
attack.
No neurological deficit can
detectable.
Incidence in the UK 27
cases per 100,000
persons in the
population.
Previous studies USA
6/100,000 women’s &
3.5/100,000 men’s in a
F:M ratio of 1.75:1
In men aged>80
incidence is
45.2/100,000
More common after the
age of 40
Right side of the face is
more commonly
affected than the left.
Idoipathic – 90%
Compression
Blood vessels may press on
the trigeminal nerve as it
leaves the brainstem at its
nerve root in the cerebello-
pontine angle. Compression
of the nerve leads to
demyelination resulting in
spontaneous generation of
the electric impulses.
Degeneration
Some have postulated it to be
part of the aging process, as
with increasing age the brain
atrophies, leading to
redundant arterial loops
which can cause
compression.
Myelin sheath infiltration
In tumor or Amyloidosis
Secondary
(Symptomatic) TN
Atypical TN Pre TN
Cerebello- pontine
angle tumor may
cause compression
in some pts
(Younger patients)
Multiple sclerosis:
2-3% of patient
with TN may have
MS
Hypertension is a
risk factor (More in
females)
Without treatment, typical
TN (TN1) may transform
over time to become
atypical TN (TN2).
A change in the character of
the pain occurs to more
constant & background pain
& the development of
sensory impairment.
Therefore, some authorities
recommend early
intervention to give the
opportunity of pain relief
without sensory deficits.
There are some reports of the existence of a
pain condition termed pre TN.
Patients who subsequently develop typical TN
may experience a prodromal pain termed
“Pre TN”.
The prodromal pain is experience as a
toothache or sinusitis like pain lasting up to
several hours sometimes triggered by jaw
movements or by drinking hot or cold liquid.
Typical TN develops a few days to several
years later, and in all cases affected the same
division of the trigeminal nerve.
This becomes pain free when using
carbamazepine or baclofen.
Recognition avoids unnecessary irreversible
dental procedures.
8. 7
Diagnostic criteria for classical TN
A. Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting one or
more divisions if the trigeminal nerve & fulfilling criteria B-C.
B. Pain has at least 1 of the following characteristics:
Intense/ Sharp/ Superficial/ Stabbing/ precipitated from trigger areas or by trigger factors.
C. Attacks are stereotyped in the individual pts.
D. There is no clinically evident neurological deficit.
E. Not attributed to another disorder.
Diagnosis of TN
1. History
2. Clinical examination to rule out other pathology including dental causes.
3. Cranial nerve function test
4. Diagnosis is conclusive if one or more attacks occur during history taking or clinical examination
when clinician can witness the “tic”
5. MRI to rule out the tumors in the cerebello- pontine angle mostly in young patients and
medically uncontrollable cases.
Treatment of trigeminal neuralgia.
Pharmacological Surgical intervention
1. Single drug therapy
2. Multiple drug therapy in “breakthrough pain”
- Carbamazepine/ oxcarbazepine is the mainstay of
treatment.
- Other drugs (usually in combination) in
breakthrough pain or when carbamazepine is
contraindicated.(Valproate/ phenytoin/
clonazepam/ gabapentin/ lamotrigine/pregabalin/
baclofen etc)
- Carbamazepine is started at a low dose: 100mg bd
or 8 hourly & increased gradually to obtain
optimum response with or without amitriptyline.
- Side effects (Dizziness) may affect compliance.
- Serious adverse effects have to be watch
Older methods
1. Peripheral (Inferior alveolar, mental, & infra
orbital branch resection) - considered less
effective.
2. Gasserian ganglion procedures- Alcohol/
phenol injections now largely abandoned.
3. Nerve root procedures- Wide sectioning of
roots – rhizotomy
Newer methods
1. Percutaneous procedures
2. Stereotactic radiosurgery or radiotherapy.
3. Posterior fossa exploration & micro vascular
decompression (MVD) of the trigeminal
root(more surgical morbidity, however)
Prognosis of TN
- 1/3 of patients will have mild symptoms.
- Some pts only ever have one episode
- Many peoples have period of remission with no pain for months or years.
9. 8
- Unconfirmed evidence that in many people it becomes more severe & less responsive to treatment
with time.
Condition Factors
Maxillary
sinusitis
Can be unilateral or bilateral, felt on the face
Acute or chronic stage of sinusitis
Dull ache exacerbated by head movements particularly lowering the head- more
in bilateral than in unilateral.
Pain may be felt in the maxillary teeth. TTP may present mostly in acute
Nasal congestion may be present.
Occipitomental radiograph may reveal radio opacity/cloudiness of the maxillary
sinus(es) A fluid level may be seen in the acute maxillary sinusitis.
Mx
Mostly medical
Antibiotics given mainly for the chronic sinusitis.
Nasal decongestant
Antihistamines
Steam inhalation
Functional endoscopic sinus surgery (FESS) by ENT surgeons
Migraine
A neurovascular pain sometimes proceeded by visual or sensory aura
Throbbing or pulsatile pain
Localized in the fronto-temporal & ocular area, but can be felt anywhere around
the head.
Photophobia or phonophobia may be found
Nausea & vomiting may occur
DD of TN
Migranous
neuralgia(Cluster
headache)
Nuerovascular pain
No aura
Severe pain, strictly unilateral, retro orbital or periorbital radiating to the jaws
sometimes.
May be confused with TN(but consider as worse than the TN. Because each
attack last longer than in the TN)
Accompanied by ipsilateral lacrimation, conjunctival injection, nasal discharge or
congestion
Each cluster is consists of 8 attacks per day or less during sleep or early morning
hours.
Attacks lasts from 5-100 minutes to few hours.
Glossopharyngeal
neuralgia
Repeated episodes of severe unilateral pain in the following areas which can
lasts from a few seconds to few minutes with similar characteristics as TN
Back of the nose & throat
Back of the tongue
Ear
Throat
Tonsil area
Voice box(Larynx)
Management on similar lines as for TN
10. 9
Atypical
Odontalgia
A form of tooth ache present in apparently normal teeth.
Intra oral equivalent of atypical facial pain.
Generally dull pain, often moves from one tooth to another – lasts for period of
4 months to several years.
Cause is not yet clear
Diagnosis by exclusion.
Rx is tricyclic or other types of antidepressants.
Temporal
arteritis
Commonest form of giant cell arteritis affecting the Head & Neck blood vessels.
An autoimmune disease.
Affects mostly superficial temporal artery & ophthalmic branch.
Affects mostly the elderly.
Insidious in development over weeks/ months commonly presents as headache
in the temporal region with tenderness along the course of the artery.
Jaw pain brought on by chewing/ talking due to ischemia of masseters.
Risk of blindness due to ophthalmic artery involvement.
Diagnosis may require temporal artery biopsy.
ESR or C - reactive protein is very highly elevated.
Treatment is by steroids/ immunosuppressive therapy.
Oral dysaesthesia
or Burning pain
in the mouth.
Due to clinically identifiable pathology.
Ulcerations
OSMF
Due to causes that are not visible in the mouth
Dry mouth
Deficiency of hematinic
Drugs eg captopril
DM
Depression
Burning mouth
syndrome
This term is not applied for burning sensation due to identifiable causes except in
association with psychogenic depression.
However it is also considered a continuous neuropathic pain
A diagnosis by exclusion
Patient should be handle with empathy.
Rx is by counseling & antidepressant therapy
Atypical facial
pain
Not attributed by any identifiable causes.
Diagnosis by exclusion
Patient should be handle with empathy.
Rx is counseling & antidepressants.