The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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.
The document discusses the management of endodontic pain. It defines pain and describes the various causes of pre-treatment, during treatment, and post-treatment endodontic pain. It outlines strategies for diagnosing the source of pain and discusses both pharmacological and non-pharmacological options for managing different types of endodontic pain, including the use of analgesics, local anesthetics, antibiotics, and steroids. Challenges in achieving pulpal anesthesia for teeth with irreversible pulpitis ("hot tooth") are also covered, along with strategies for improving anesthesia success.
This document provides an overview of pain and pain pathways. It defines pain, discusses its history and characteristics. It describes the classification and receptors of pain, as well as the chemical mediators and neural pathways involved in pain transmission and modulation. Specifically, it outlines the three orders of sensory neurons - first order neurons transmit signals from receptors to the spinal cord, second order neurons relay signals within the spinal cord, and third order neurons transmit signals from the spinal cord to the brain. It also briefly discusses theories of pain transmission and modulation.
Digital imaging systems provide advantages over traditional radiography such as immediate image viewing and sharing, enhanced images, reduced radiation exposure, and electronic storage. The document discusses the history of x-rays, compares digital and traditional radiography, and reviews several popular intraoral digital systems. Key factors to consider when purchasing a digital system include sensor size and shape, software features, computer hardware, and service and support.
Temporomandibular Dysfunctions – Part 2 History, Clinical Examination and Dia...Dr. Bishow Prakash Thakur
The document discusses the history, clinical examination, and diagnosis of temporomandibular dysfunctions. It covers topics like screening history questions, cranial nerve examinations, muscle examinations, temporomandibular joint examinations, and functional manipulation tests. The goal of the history and examination is to identify signs and symptoms, rule out other possible disorders, and accurately diagnose temporomandibular disorders. A thorough examination of the masticatory system and related structures is important for diagnosis.
This document provides information on pain management. It begins with the history and theories of pain. It then discusses the neurophysiology of pain including nociception, transmission, modulation and perception. Gate control theory is explained in detail. Non-pharmacological approaches like rest, distraction, electrotherapy and exercise are covered. The WHO analgesic ladder is introduced and different classes of pharmacological pain medications like non-opioids, opioids, antidepressants and antiepileptics are summarized.
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.
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.
The document discusses the management of endodontic pain. It defines pain and describes the various causes of pre-treatment, during treatment, and post-treatment endodontic pain. It outlines strategies for diagnosing the source of pain and discusses both pharmacological and non-pharmacological options for managing different types of endodontic pain, including the use of analgesics, local anesthetics, antibiotics, and steroids. Challenges in achieving pulpal anesthesia for teeth with irreversible pulpitis ("hot tooth") are also covered, along with strategies for improving anesthesia success.
This document provides an overview of pain and pain pathways. It defines pain, discusses its history and characteristics. It describes the classification and receptors of pain, as well as the chemical mediators and neural pathways involved in pain transmission and modulation. Specifically, it outlines the three orders of sensory neurons - first order neurons transmit signals from receptors to the spinal cord, second order neurons relay signals within the spinal cord, and third order neurons transmit signals from the spinal cord to the brain. It also briefly discusses theories of pain transmission and modulation.
Digital imaging systems provide advantages over traditional radiography such as immediate image viewing and sharing, enhanced images, reduced radiation exposure, and electronic storage. The document discusses the history of x-rays, compares digital and traditional radiography, and reviews several popular intraoral digital systems. Key factors to consider when purchasing a digital system include sensor size and shape, software features, computer hardware, and service and support.
Temporomandibular Dysfunctions – Part 2 History, Clinical Examination and Dia...Dr. Bishow Prakash Thakur
The document discusses the history, clinical examination, and diagnosis of temporomandibular dysfunctions. It covers topics like screening history questions, cranial nerve examinations, muscle examinations, temporomandibular joint examinations, and functional manipulation tests. The goal of the history and examination is to identify signs and symptoms, rule out other possible disorders, and accurately diagnose temporomandibular disorders. A thorough examination of the masticatory system and related structures is important for diagnosis.
This document provides information on pain management. It begins with the history and theories of pain. It then discusses the neurophysiology of pain including nociception, transmission, modulation and perception. Gate control theory is explained in detail. Non-pharmacological approaches like rest, distraction, electrotherapy and exercise are covered. The WHO analgesic ladder is introduced and different classes of pharmacological pain medications like non-opioids, opioids, antidepressants and antiepileptics are summarized.
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.
Here are some key resources on pain and anxiety control in dentistry:
- Sturdvent - A leading manufacturer of dental equipment for pain and anxiety control.
- Ada's journal on anxiety and pain control - The American Dental Association's journal focused on non-pharmacological approaches.
- Journal on pain management by the American Society of Endodontists - Focuses on managing endodontic pain.
- Journal on pain control in dentistry - Focused specifically on controlling pain during various dental procedures.
- Pickard's manual of operative dentistry - A comprehensive textbook covering techniques for operative dentistry including pain control.
- Pain control in operative dentistry by Dr Ann Elrich - A
Radiography is essential for endodontic diagnosis, treatment, and evaluation of treatment outcomes. It helps determine pulpal and periapical pathology, root and canal morphology, working lengths, location of missed canals, and quality of obturation. Key radiographic views include diagnostic, working length, post-treatment, and recall films. Diagnostic films aim to visualize 3-4mm beyond the apex to identify lesions. Angulation and tube shift techniques help differentiate superimposed structures. Features like lamina dura continuity, lesion borders, density and effects on adjacent structures aid diagnosis. Newer technologies include digital radiography and cone beam CT for improved visualization of complex anatomy.
The document discusses pain and its management. It defines pain and describes different types of pain like neuralgia and neuropathic pain. It discusses medical management of pain including medications like NSAIDs, opioids, and anticonvulsants. NSAIDs discussed include aspirin, ibuprofen, and ketorolac. Opioids discussed include morphine, codeine, oxycodone, and tramadol. The document provides dosing information for these medications and strategies for optimizing pain management.
This document discusses space maintainers, which are appliances used to maintain space after premature loss of primary teeth. It defines space maintainers and describes their important functions. The main causes of premature primary tooth loss are caries, trauma, ectopic eruption, and systemic disorders. Premature loss can lead to undesirable tooth movement and malocclusion. The document discusses factors that influence space closure rate and direction, as well as treatment considerations for timely space maintenance. It also outlines types of space maintainers, including fixed and removable, and their advantages and disadvantages.
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
This document discusses analgesics used in dentistry, focusing on NSAIDs. It defines NSAIDs and explains their mechanism of action as inhibiting the cyclooxygenase enzymes, thereby reducing the formation of prostaglandins. The document classifies NSAIDs chemically and by mechanism of action. It outlines the indications of NSAIDs in dentistry and discusses commonly used NSAIDs, their pharmacokinetics, pharmacodynamics, adverse effects, and interactions. The document also briefly discusses opioids and their uses, mechanisms of action, and considerations.
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 lecture, which oriented to the level of mind of undergraduate students, discuss the topic of pulpectomy, its indications, contraindications, and procedural steps.
Visit us on Facebook:
https://www.facebook.com/iraqi.Dental.Academy
1) The temporomandibular joint (TMJ) is a synovial joint that connects the mandible to the temporal bone. It has several parts including the articular eminence, fossa, condyle, capsule, ligaments, synovial fluid, and articular disc.
2) The articular disc sits between the condyle and fossa and divides the joint into two compartments. It allows the condyle to glide forward during opening and back during closing.
3) Four jaw muscles work in coordination to produce movements like opening, closing, protruding, and grinding. The lateral pterygoid muscle plays a key role in pulling the disc as the jaw opens
This document provides information on full crown tooth preparations, including definitions, biological and mechanical principles, and guidelines. It discusses the importance of margin location in relation to the biologic width to maintain gingival health. It also covers principles such as preservation of tooth structure, retention and resistance form, and considerations for different crest relationships to minimize risk of tissue recession. Guidelines are provided for preparation taper, height and diameter to enhance durability and resistance to dislodging forces.
The document discusses various aspects of root canal obturation including definitions, purposes, techniques, and materials. Obturation involves filling and sealing the cleaned and shaped root canal using gutta-percha and a sealer. The goals are to achieve a fluid-tight seal, prevent microleakage and reinfection. Common techniques include cold lateral compaction, warm vertical compaction using heat carriers, continuous wave compaction, and thermoplasticized gutta-percha injection. Carrier-based techniques like Thermafil and SimpliFill are also described. Key factors for treatment success include absence of preoperative lesions, void-free fillings, obturation within 2mm of the apex, and adequate coronal restoration
The document discusses factors to consider when selecting abutment teeth for fixed partial dentures. Key factors include the location, position, and condition of the tooth, as well as characteristics of the crown, root, supporting bone, and periodontal ligament area. Ideal abutment teeth are those adjacent to edentulous spaces, have sufficient root length and structure, and provide adequate periodontal ligament area to support the prosthesis based on Ante's law. Abutment teeth should be vital or endodontically treated as needed and have healthy bone support.
This document provides information on intracanal medicaments used in endodontic treatment. It defines intracanal medicaments as temporary medications placed in root canals to inhibit bacterial invasion and discusses their ideal requirements. Various commonly used medicaments are described, including their composition, mechanisms of action, and antimicrobial efficacy. In particular, it focuses on chlorhexidine, formocresol, calcium hydroxide, antibiotics, and corticosteroid combinations such as Ledermix paste. The document also reviews the root canal and deciduous tooth microflora that intracanal medicaments aim to eliminate.
This fresh lecture explain the basics of antibiotic prescription, and common interactions, clinical use, and dosages. It is written to level of undergraduate mind
This document discusses orthopedic appliances used for growth modification. It describes three main types of orthopedic appliances: headgears, protraction face masks, and chin cups. Headgears are the most widely used and can be cervical, occipital, or a combination to modify maxillary growth. Protraction face masks apply an anterior protractory force on the maxilla through facial anchorage from the chin and/or forehead. Chin cups provide anchorage from the chin area. The key principles of orthopedic appliance therapy are applying heavy intermittent forces through teeth to modify bone growth at sutures and growth sites.
Periapical, bitewing, and occlusal radiographs provide different views for assessing teeth and surrounding structures. Periapical views show crowns, roots, and bone while bitewings show interproximal areas and the alveolar crest. Occlusals display large segments of dental arches. Each view has advantages like accuracy but also disadvantages like patient discomfort. Proper technique like receptor placement and central ray angulation are needed to minimize distortion. Managing pediatric patients and those prone to gagging requires relaxation, explanation, and distraction techniques.
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.
Here are some key resources on pain and anxiety control in dentistry:
- Sturdvent - A leading manufacturer of dental equipment for pain and anxiety control.
- Ada's journal on anxiety and pain control - The American Dental Association's journal focused on non-pharmacological approaches.
- Journal on pain management by the American Society of Endodontists - Focuses on managing endodontic pain.
- Journal on pain control in dentistry - Focused specifically on controlling pain during various dental procedures.
- Pickard's manual of operative dentistry - A comprehensive textbook covering techniques for operative dentistry including pain control.
- Pain control in operative dentistry by Dr Ann Elrich - A
Radiography is essential for endodontic diagnosis, treatment, and evaluation of treatment outcomes. It helps determine pulpal and periapical pathology, root and canal morphology, working lengths, location of missed canals, and quality of obturation. Key radiographic views include diagnostic, working length, post-treatment, and recall films. Diagnostic films aim to visualize 3-4mm beyond the apex to identify lesions. Angulation and tube shift techniques help differentiate superimposed structures. Features like lamina dura continuity, lesion borders, density and effects on adjacent structures aid diagnosis. Newer technologies include digital radiography and cone beam CT for improved visualization of complex anatomy.
The document discusses pain and its management. It defines pain and describes different types of pain like neuralgia and neuropathic pain. It discusses medical management of pain including medications like NSAIDs, opioids, and anticonvulsants. NSAIDs discussed include aspirin, ibuprofen, and ketorolac. Opioids discussed include morphine, codeine, oxycodone, and tramadol. The document provides dosing information for these medications and strategies for optimizing pain management.
This document discusses space maintainers, which are appliances used to maintain space after premature loss of primary teeth. It defines space maintainers and describes their important functions. The main causes of premature primary tooth loss are caries, trauma, ectopic eruption, and systemic disorders. Premature loss can lead to undesirable tooth movement and malocclusion. The document discusses factors that influence space closure rate and direction, as well as treatment considerations for timely space maintenance. It also outlines types of space maintainers, including fixed and removable, and their advantages and disadvantages.
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
This document discusses analgesics used in dentistry, focusing on NSAIDs. It defines NSAIDs and explains their mechanism of action as inhibiting the cyclooxygenase enzymes, thereby reducing the formation of prostaglandins. The document classifies NSAIDs chemically and by mechanism of action. It outlines the indications of NSAIDs in dentistry and discusses commonly used NSAIDs, their pharmacokinetics, pharmacodynamics, adverse effects, and interactions. The document also briefly discusses opioids and their uses, mechanisms of action, and considerations.
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 lecture, which oriented to the level of mind of undergraduate students, discuss the topic of pulpectomy, its indications, contraindications, and procedural steps.
Visit us on Facebook:
https://www.facebook.com/iraqi.Dental.Academy
1) The temporomandibular joint (TMJ) is a synovial joint that connects the mandible to the temporal bone. It has several parts including the articular eminence, fossa, condyle, capsule, ligaments, synovial fluid, and articular disc.
2) The articular disc sits between the condyle and fossa and divides the joint into two compartments. It allows the condyle to glide forward during opening and back during closing.
3) Four jaw muscles work in coordination to produce movements like opening, closing, protruding, and grinding. The lateral pterygoid muscle plays a key role in pulling the disc as the jaw opens
This document provides information on full crown tooth preparations, including definitions, biological and mechanical principles, and guidelines. It discusses the importance of margin location in relation to the biologic width to maintain gingival health. It also covers principles such as preservation of tooth structure, retention and resistance form, and considerations for different crest relationships to minimize risk of tissue recession. Guidelines are provided for preparation taper, height and diameter to enhance durability and resistance to dislodging forces.
The document discusses various aspects of root canal obturation including definitions, purposes, techniques, and materials. Obturation involves filling and sealing the cleaned and shaped root canal using gutta-percha and a sealer. The goals are to achieve a fluid-tight seal, prevent microleakage and reinfection. Common techniques include cold lateral compaction, warm vertical compaction using heat carriers, continuous wave compaction, and thermoplasticized gutta-percha injection. Carrier-based techniques like Thermafil and SimpliFill are also described. Key factors for treatment success include absence of preoperative lesions, void-free fillings, obturation within 2mm of the apex, and adequate coronal restoration
The document discusses factors to consider when selecting abutment teeth for fixed partial dentures. Key factors include the location, position, and condition of the tooth, as well as characteristics of the crown, root, supporting bone, and periodontal ligament area. Ideal abutment teeth are those adjacent to edentulous spaces, have sufficient root length and structure, and provide adequate periodontal ligament area to support the prosthesis based on Ante's law. Abutment teeth should be vital or endodontically treated as needed and have healthy bone support.
This document provides information on intracanal medicaments used in endodontic treatment. It defines intracanal medicaments as temporary medications placed in root canals to inhibit bacterial invasion and discusses their ideal requirements. Various commonly used medicaments are described, including their composition, mechanisms of action, and antimicrobial efficacy. In particular, it focuses on chlorhexidine, formocresol, calcium hydroxide, antibiotics, and corticosteroid combinations such as Ledermix paste. The document also reviews the root canal and deciduous tooth microflora that intracanal medicaments aim to eliminate.
This fresh lecture explain the basics of antibiotic prescription, and common interactions, clinical use, and dosages. It is written to level of undergraduate mind
This document discusses orthopedic appliances used for growth modification. It describes three main types of orthopedic appliances: headgears, protraction face masks, and chin cups. Headgears are the most widely used and can be cervical, occipital, or a combination to modify maxillary growth. Protraction face masks apply an anterior protractory force on the maxilla through facial anchorage from the chin and/or forehead. Chin cups provide anchorage from the chin area. The key principles of orthopedic appliance therapy are applying heavy intermittent forces through teeth to modify bone growth at sutures and growth sites.
Periapical, bitewing, and occlusal radiographs provide different views for assessing teeth and surrounding structures. Periapical views show crowns, roots, and bone while bitewings show interproximal areas and the alveolar crest. Occlusals display large segments of dental arches. Each view has advantages like accuracy but also disadvantages like patient discomfort. Proper technique like receptor placement and central ray angulation are needed to minimize distortion. Managing pediatric patients and those prone to gagging requires relaxation, explanation, and distraction techniques.
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.
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is initiated by specialized nerve endings called nociceptors and transmitted by neurons. There are four processes involved in pain: transduction, transmission, modulation, and perception. Pain can be classified as nociceptive (resulting from tissue damage) or neuropathic (resulting from damage or disease affecting the nervous system). A thorough history and clinical/radiographic examination is needed to diagnose the source and type of pain. Common sources of dental pain include pulpal and periapical diseases, periodontal diseases, fractures, cysts, and tumors. Non-dental sources can also mimic dental pain and should be considered.
Facial pain can be caused by conditions like trigeminal neuralgia, migraines, post-herpetic neuralgia, and temporomandibular arthritis. Trigeminal neuralgia causes sharp, stabbing pain on one side of the face and is often triggered by mundane activities like washing, shaving, or talking. It is commonly treated with medications or microvascular decompression surgery. Post-herpetic neuralgia is nerve pain that develops after a shingles outbreak and is confined to the affected dermatome. Temporomandibular arthritis, also called Costen's syndrome, produces severe aching pain in the jaw worsened by chewing and is linked to dental issues. Diagnosis
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.
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.
Endodontic pain can be odontogenic or non-odontogenic in origin. Odontogenic pain includes pulpal pain from reversible or irreversible pulpitis, as well as pain from periapical/periodontal conditions like acute apical periodontitis. Pulpal pain ranges from mild hypersensitive pulpalgia to severe advanced acute pulpalgia. Non-odontogenic pain includes musculoskeletal, neuropathic, neurovascular, inflammatory and systemic conditions. A thorough history and clinical/radiographic examination is needed to diagnose the source and type of endodontic pain present. Appropriate testing and treatment options are then selected.
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.
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.
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.
Innervation of the face
The nervvous system
Nerve transmission
Definition of Pain
Pain Receptors
Pain nerve fibers
Reaction to pain
Pain Pathway
Control of Pain
Mode of action of local anesthesia
This document discusses trigeminal neuralgia and facial palsy. It begins by defining neuralgia as pain along the distribution of a nerve. It then classifies trigeminal neuralgia as the most debilitating form of neuralgia affecting the trigeminal nerve. It describes facial palsy as paralysis of the facial nerve causing an inability to control facial muscles. The document provides details on the anatomy, causes, symptoms, diagnosis and treatment of both conditions.
The temporomandibular joint (TMJ) permits the mandible to move through gliding and hinge movements. It consists of the mandibular condyle, mandibular fossa, articular disc, and articular capsule. The condyle articulates with the fossa and articular eminence, while the articular disc separates the joint into upper and lower compartments. The joint capsule surrounds the joint and is lined with a synovial membrane that produces lubricating synovial fluid. Accessory ligaments and the lateral temporomandibular ligament provide stability to the joint. The TMJ undergoes age-related changes including flattening of the condyle and thinning of the
This document discusses various methods for controlling pain in operative dentistry. It describes local anesthesia as the most commonly used method, where anesthetic solutions are injected near nerves to temporarily block pain transmission. Other options include inhalation sedation using nitrous oxide, premedication with anti-anxiety medications, hypnosis, and electronic dental anesthesia. Proper injection technique and local anesthetic agents are outlined. Care during procedures like use of rubber dams and slow burs can further reduce pain and trauma for patients.
The document provides an overview of the anatomy, development, and surgical anatomy of the temporomandibular joint (TMJ). It discusses the key components of the TMJ, including the mandibular condyle, articular surfaces of the temporal bone, articular disc, fibrous capsule, and ligaments. It describes the development of the TMJ from two distinct blastemas beginning in the 7th week in utero. The document highlights several unique features of the TMJ, such as its articular surface being covered by fibrocartilage instead of hyaline cartilage. It also reviews the movements, vascular supply, innervation, and age-related changes of the TMJ.
This document discusses pain in several sections:
1. It defines pain and its subjective nature. Pain is the most common reason people seek medical care and acts as a protective mechanism.
2. It describes pain transmission and the gate control theory of pain. Nociceptors transmit pain impulses and can be modulated by other stimuli.
3. It categorizes acute, chronic, and cancer-related pain and discusses factors influencing individual pain responses. Non-pharmacological and pharmacological pain management strategies are also outlined.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses pain from several perspectives. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It then provides a brief history of how pain was viewed in different time periods and cultures from ancient Greece to the Bible. It also explains the SOCRATES mnemonic used to evaluate pain based on site, onset, character, radiation, associations, time course, exacerbating/relieving factors, and severity. Finally, it lists examples for each component of the SOCRATES evaluation framework to aid health professionals in assessing a patient's pain.
The document discusses various topics related to pain management including:
1. Definitions of types of pain such as neuropathic pain and definitions of clinical terms like allodynia and hyperalgesia.
2. Components of a thorough pain assessment including history, physical exam, and use of scales.
3. Non-pharmacological and pharmacological approaches to pain treatment including opioids, adjuvants, and management of side effects.
4. Differences between tolerance, physical dependence, and psychological dependence/addiction in relation to opioids.
5. Protocols for managing incident or breakthrough pain with fentanyl or sufentanil.
This document summarizes the ascending and descending tracts of the central nervous system. It describes the functional anatomy and regional anatomy of the ascending tracts that transmit sensory information from the periphery to the brain, including the dorsal column-medial lemniscal system and anterolateral system. It also discusses the different classes of sensory receptors, pathways, and relay nuclei involved in transmitting different somatic sensations like touch, proprioception, pain, itch and temperature.
Peripheral Nervous System, Audumbar MaliAudumbar Mali
Peripheral Nervous System,
Types of PNS,
Spinal nerves,
Types of neuron (3 basic types),
Plexus,
Cranial nerves,
Autonomic nervous system,
Structure of Neuron,
Human Anatomy and Physiology-I,
Syllabus As per PCI,
B. Pharm-I
Nerve supply of head & neck by Dr. Amit Suryawanshi .Oral & Maxillofacial ...All Good Things
Description:
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
Nerve supply of head & neck by Dr. Amit T. Suryawanshi, Oral Surgeon, Pune All Good Things
Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best.
The document discusses ascending pathways in the spinal cord that transmit sensory information to the brain. There are two main pathways - the spinothalamic pathway carries pain and temperature sensations while the dorsal column pathway carries touch, proprioception, and vibration sensations. Both have three neurons with the first receiving input from receptors and synapsing in the spinal cord, the second carrying signals to the thalamus, and the third projecting to the somatosensory cortex. The cortex contains a sensory homunculus map of the body. Damage to ascending pathways can cause syndromes like Brown-Sequard.
The document discusses pain and its pathways in the human body. It defines pain and describes its characteristics and theories. It discusses the neurochemistry and types of pain receptors. The main pain pathway described is the lateral spinothalamic tract, which carries pain and temperature sensations from the periphery to the thalamus and somatosensory cortex via the dorsal horn and spinal cord. It relays information via three orders of neurons and can be modulated in the substantia gelatinosa of the spinal cord.
The document provides an overview of pain pathways, including definitions, classifications, theories, components, and genetics involved in pain transmission. It discusses the various structures and pathways involved in pain processing, from nociceptors and receptors in tissues, to nerve fibers, neurotransmitters, the spinal cord, brainstem, thalamus, and cortex. Both ascending and descending pain pathways are described. Finally, the document outlines assessment and management approaches for acute and chronic pain.
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Neurological Basis Of Behavior Presentation.pptxMahekShaikh72
The document discusses neurons, synapses, and neurotransmitters. It begins by describing the structure of neurons including dendrites, cell body, and axon. There are two main types of synapses - electrical and chemical. Chemical synapses transmit signals across a synaptic cleft using neurotransmitters stored in synaptic vesicles. The central and peripheral nervous systems are described along with their components like the brain, spinal cord, and nerves. Key neurotransmitters are discussed and how they work by being released from neurons and binding to receptors on target cells to trigger actions.
an overview of the ascending tract of the spinal cord....an anatomical approach to understand the somato-sensory pathway.
Prepared as a class presentation .
This document discusses sensory and motor pathways in the human body. It begins by listing the key learning outcomes, which include describing sensory receptors, pathways in the spinal cord and brain, motor neurons and tracts, and the corticospinal tract. It then discusses myelinated and non-myelinated nerve fibers, how they conduct impulses, and their roles. The document proceeds to explain sensory pathways from receptors to the brain, motor pathways from the brain to muscles, and provides diagrams of sensory and motor tracts in the spinal cord. It concludes by describing functions of sensory and motor neurons.
The nervous system consists of sensory, motor, and higher functional parts. There is continuous information flow between the brain, spinal cord, and peripheral nerves via sensory and motor pathways. The main pathways that carry sensory information are the posterior column pathway, anterolateral pathway, and spinocerebellar pathway. The posterior column pathway carries fine touch, proprioception, vibration and stereognosis sensations via the dorsal column-medial lemniscus tract. The anterolateral pathway carries pain and temperature sensations via the spinothalamic tracts. The spinocerebellar pathway relays proprioceptive information to the cerebellum.
The nervous system consists of neurons and neuroglial cells. Neurons transmit nerve impulses through electrical and chemical signals. The neuron has a cell body, dendrites which receive signals, and an axon which transmits signals. Schwann cells wrap around axons and form myelin sheaths to aid impulse conduction. The nervous system regulates sensation, movement, and organ function through sensory, motor and interneurons. Nerve impulses rely on ion exchange and are transmitted across synapses using neurotransmitters. The central and peripheral nervous systems work together to control all bodily functions.
The nervous system consists of neurons and neuroglial cells. Neurons transmit nerve impulses through electrical and chemical signals. The neuron has a cell body, dendrites which receive signals, and an axon which transmits signals. Schwann cells wrap around axons and form myelin sheaths to insulate axons. Myelin allows faster impulse transmission. The nervous system regulates sensation, movement, and organ function through sensory, motor and interneurons. Nerve impulses rely on ion exchange and travel through the nervous system via pathways and reflex arcs.
The nervous system consists of neurons and neuroglial cells. Neurons transmit nerve impulses through electrical and chemical signals. The neuron has a cell body, dendrites which receive signals, and an axon which transmits signals. Schwann cells wrap around axons and produce myelin sheaths for insulation and faster signal transmission. The nervous system has sensory, inter, and motor neurons and performs functions like receiving information and transmitting instructions. Diseases can disrupt myelin sheaths and impair signaling.
The nervous system consists of neurons and neuroglial cells. Neurons transmit nerve impulses through electrical and chemical signals. The neuron has a cell body, dendrites which receive signals, and an axon which transmits signals. Schwann cells wrap around axons and produce myelin sheaths for insulation and faster signal transmission. The nervous system has sensory, inter, and motor neurons and performs functions like receiving information and transmitting instructions. Diseases can disrupt myelin sheaths and impair signaling.
This document discusses the anatomy and physiology of pain. It defines pain and describes its sensory and emotional components. It outlines the neurobiology of pain, including transduction, transmission, modulation, and perception. It discusses nociceptors, sensitization, and the gate control theory of pain. It describes the peripheral and central nervous system pathways involved in pain, including the dorsal horn, ascending pathways, descending modulation, and supraspinal regions. It also discusses complex regional pain syndromes.
The nervous system is made up of the central nervous system and the peripheral nervous system. The central nervous system (CNS) is made up of the brain and spinal cord. The brain controls most body functions, including awareness, movements, sensations, thoughts, speech and memory.
Similar to Orofacial pain/ oral surgery courses (20)
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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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.
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.
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.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
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In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
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.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
2. Contents-Part-I
The Nature of Pain
• Defination
• Neural anatomy of orofacial pain
• Neurophysiology of orofacial pain
• Central processing and Psychology of pain
Clinical considerations of pain
• Measurement of Pain and Disability
• History of Orofacial pain
• Orofacial Pain Clinical examination
• Establishing the pain category
• Confirmation of clinical diagnosis
Classification of orofacial painwww.indiandentalacademy.com
3. Part-II
• Clinical pain Syndromes
• General Considerations in Managing
Orofacial pains.
www.indiandentalacademy.com
4. Introduction
Orofacial pain derives from a vast number of complex etiologies
and its successful treatment requires contributions from many
different specialties.
This pain is one of the most distressing of all painful syndromes and
warrants aggressive and appropriate treatment in a multidisciplinary
setting.
The assessment of head and neck pain requires a careful physical
examination of multiple structures and systems, a thorough history, and
the employment of auxiliary diagnostic studies.
www.indiandentalacademy.com
5. The Nature Of Pain
• Defination proposed by the subcommittee on taxonomy
of the International Association for the study of pain.
“It is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage or
described in terms of such damage.”
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6. Levels of Pain processing
• Nociception-refers to noxious stimulus originating from
the sensory receptors.The information is carried to the
central nervous system by the primary afferent neurons.
• Pain-Is an unpleasant sensation perceived in the cortex
usually as a result of incoming nociceptive input.
• Suffering-refers to how the human reacts to the
perception of pain.
• Pain behaviour-refers to individual’s audible and visible
actions that communicate his or her suffering to others.
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7. Neural pathways of pain
• Transduction-is the process by which noxious stimuli
lead to electrical activity in the appropriate sensory nerve
ending.
• Transmission-The neural events that carry the
nociceptive input into the central nervous system for
proper processing.
• Modulation –is the ability of the central nervous system
to control the pain transmitting neurons.
• Perception-If nociceptive input reaches the cortex,
perception occurs,which immediately initiates a complex
interaction of neurons between the higher centres of the
brain. www.indiandentalacademy.com
8. Functional Neuroanatomy
Sensory Receptors
• At the distal terminals of afferent (sensory) nerves are
specialized sensory receptors that respond to physical or
chemical stimuli. Once these receptors have been
adequately stimulated, an impulse is generated in the
primary afferent neuron that is carried centrally into the
CNS.
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9. They are classified into three groups-
a)Exteroceptors- Provides information from skin
and mucosa
b) Proprioceptors- Provides information from
musculoskeletal structures concerning
presence,position and movement of the body.
c) Interoceptors- Provides information from
viscera.
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10. The First-Order Neuron
• Each sensory receptor is attached to a first-order or
primary afferent neuron that carries the impulses to the
CNS.
• A general classification of neurons divides the larger
fibers from the smaller ones, calling the larger fibers A
fibers and the smaller fibers C fibers.
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11. • The A fibers are further divided by diameter size into
alpha, beta, gamma, and delta.
• It appears that the fast conducting A-alpha, A-beta, and
A-gamma fibers carry impulses that induce tactile and
proprioceptive responses but not pain.
• It seems that pain is conducted by A-delta and C fibers,
but these are not specific for pain only. The pricking
sensation by A-delta, the burning sensation by C fibers.
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12. Second-Order Neuron
• The primary afferent neuron carries impulses into the
CNS and synapses with the second-order neuron.
• This second-order neuron is sometimes called a
transmission neuron since it transfers the impulse on to
the higher centers.
• The synapse of the primary afferent and the second-
order neuron occurs in the dorsal horn of the spinal cord
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13. There are three specific types of second-order neurons that
transfer impulses to the higher centers and are named
according to the type of impulses they predominantly carry.
1) Low-threshold mechanosensitive neurons (LTM)
-transfer information of light touch, pressure and
proprioception.
2) Nociceptive specific neurons (NS)- exclusively carry
impulses related to noxious stimulation.
3) Wide dynamic range neuron (WDR)- This neuron is
able to respond to a wide range of stimulus intensities
from non-noxious to noxious.
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14. • Once the impulses have been transferred from the
primary afferents, most of the second-order neurons
cross to the opposite side of the spinal cord and enter
the antero-lateral spinothalamic tract, which ascends to
the higher centers.
• Some of the second-order neurons remain on the same
side of the dorsal column and ascend by way of the
lemniscal system.
www.indiandentalacademy.com
19. Brain Stem and Brain
Once the impulses have been passed to the second-order
neurons, these neurons carry them to the higher centers
for interpretation and evaluation.
www.indiandentalacademy.com
21. The higher centers of the central nervous system can be subdivided
into the following four regions from the most inferior to the most
superior:
• The brain stem made up of the medulla
oblongata, the pons, and the midbrain
(or mesencephalon).
• The cerebellum.
• The diencephalon is made up of the
thalamus and hypothalamus
• The cerebrum made up of the cerebral cortex, the basal ganglia,
and the limbic structures
www.indiandentalacademy.com
22. Second order neurons
↓
Medulla(either enhances or inhibits impulses to the brain)
↓
Thalamus (Relay station-makes assessments and directs
the impulses to appropriate regions)
↓
Cortex (Perceives the pain)
www.indiandentalacademy.com
24. • A graphic depiction of the trigeminal nerve entering the
brain stem at the level of the pons.
• The primary afferent neuron (1st N) enters the brain
stem to synapse with a second-order neuron (2nd Nj in
the trigeminal spinal tract nucleus (STN of V).
• The spinal tract nucleus is divided into three regions; the
subnucleus oralis (nso), the subnucleus interpolaris (sni),
and the subnucleus caudalis (snc).
www.indiandentalacademy.com
25. • The trigeminal brain stem complex is also composed of
the motor nucleus of V (MN of V) and the main sensory
nucleus of V (SN of V).
• The cell bodies of the trigeminal nerve are located in the
gasserian ganglion (GG).
• Once the second-order neuron receives the input it is
carried on to the thalamus (Th) for interpretation.
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26. The relationship of the trigeminal nerve input and the spinal nerve input
as impulses ascend to the higher centers
www.indiandentalacademy.com
28. Generation of Action Potential:
a) Resting membrane potential (RMP) at -70mV. Na+ on
outside and K+ on inside of cell
b) As depolarization reaches threshold of -55mV, the
action potential is triggered and Na+ rushes into cell.
Membrane potential reaches +30mV on action potential
c) Propagation of the action potential at 100 m/sec
(which is 225 mph)
d) Repolarization occurs with K+ exiting the cell to return
to -70mV RMP
e) Return of ions (Na+ and K+) to their extracellular and
intracellular sites by the sodium potassium (Na+K+)
pump
www.indiandentalacademy.com
30. SYNAPSES
• A synapse is the junction point between two neurons.
• A nerve impulse can also be transmitted from a sensory receptor
cell to a neuron, or from a neuron to a set of muscles to make them
contract, or from a neuron to an endocrine gland to make it secrete
a hormone. In these last two cases, the connection points are called
neuromuscular and neuroglandular junctions.
• In a chemical synapse between two neurons, the neuron from which
the nerve impulse arrives is called the presynaptic neuron. The
neuron to which the neurotransmitters (chemical messengers) bind
is called the postsynaptic neuron.
• The terminal button of the presynaptic neuron’s axon contains
mitochondria as well as microtubules that transport the
neurotransmitters from the cell body (where they are produced) to
the tip of the axon.
•
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32. • This terminal button also contains spherical vesicles filled with
neurotransmitters. These neurotransmitters are secreted into the
synaptic gap by a process called exocytosis, in which the vesicles’
membranes fuse with that of the presynaptic button.
• The synaptic gap that the neurotransmitters have to cross is very
narrow–on the order of 0.02 micron.
• Across the gap, the neurotransmitters bind to membrane
receptors: large proteins anchored in the cell membrane of the
post-synaptic neuron.
• Any given neurotransmitter has receptors that are specific to it.
• It is the presence or absence of certain of these sub-types that
causes a cascade of specific chemical reactions in the postsynaptic
neuron. These reactions result in the excitation or inhibition of this
neuron.
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33. Neurotransmitters are divided into 2 types-
• Small rapid acting molecules –
Acetylcholine,Norepinephrine,Glutamate,
Aspartate,Serotonin(excitatory)
GABA,Glycine,dopamine(Inhibitory)
• Larger slower acting molecules-
Substance P, Endorphins
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34. Once the transmitter performs its function of transmitting
the impulse , it is rapidly removed by one of the three
methods:
• Diffusion
• Enzymatic Destruction
• Neurotransmitter reuptake
www.indiandentalacademy.com
35. Central processing and psychology
of pain
• A) Primary pain and heterotopic pain
• The site of the pain is the location that the patient feels
the pain.
• The source of pain is that area of the body from which
the pain actually originates .
• When the site and source of the pain are in the same
location it is called primary pain.
• If the site and source of pain are different ,then it is called
heterotopic pain. www.indiandentalacademy.com
36. Referred pain
• Referred pain is a spontaneous heterotopic pain
that is felt in an area innervated by a different
nerve from the one that mediates primary pain.
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37. • The pain originating from viscera is generally of slow,
aching type,which is difficult to localise.
• Frequently visceral pain may be referred to other parts
of the body supplied by the same spinal nerve (the
dermatomal rule) known as referred pain.
• When pain is referred to another part of the body, the
site of referral is usually a part of the body that develops
from the same embryological segment or dermatome, as
the affected source of the pain. The same peripheral
nerves supply these common regions of the body.
www.indiandentalacademy.com
38. B) Modulation Concept
• Neural impulses are altered , changed or modulated as
they travel up the neuraxis to the higher centers.
• Excitatory or inhibitory influences bear on the impulses
at various levels in the CNS,which can accentuate the
pain experience.
• The process of increasing the impulse is facilitation and
decreasing inhibition.
www.indiandentalacademy.com
39. C) Psychology of pain
• Nociception is not pain until it reaches and proceed by
higher centres.
• Once impulses reach the higher centres , patient makes
the judgement on pain experience according to at least
four factors or conditions.
Level of arousal of brain stem
Prior experiences
Emotional state
Certain behavioural traits.
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40. Measurement of Pain and Disability
Pain is a subjective experience and therefore impossible to
Measure directly, but a quantitative estimation of pain can
be obtained. However, there are only few available tests to
quantify separate aspects of pain.
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41. Visual Analogue Scale (VAS)
• VAS consists of 10cm line on which 0cm is no pain and
10cm is pain as bad as it could be. . Numeric scales (eg,
1 to 10) and descriptive rating scales (eg, no pain, mild,
moderate, severe pain) are also used.
• VASs are sensitive to treatment effects, can be
incorporated into pain diaries, and can be used with
children.
• The multidimensional aspects of pain are not well
measured by scales that rate intensity.
www.indiandentalacademy.com
42. The McGill Pain Questionnaire (MPQ)
• It was created to measure the motivational-affective and
the cognitive-evaluative qualities of pain, in addition to
the sensory experience.
• The questionnaire enables patients to choose from 78
adjectives (arranged in 20 groups) that describe pain.
www.indiandentalacademy.com
43. • The form is designed to assess the sensory (groups 1 to
10), affective (groups 11 to 15), and evaluative (group
16) dimensions of pain and to produce a pain-rating
index.
• There are also sections for the location and temporal
characteristics of pain and a rating for present pain
intensity.
www.indiandentalacademy.com
44. Turk and Rudy have developed the Multiaxial
Assessment of Pain (MAP) classification
Their assessment included a 61-item questionnaire, the
West Haven Yale Multidimensional Pain Inventory
(WHYMPI), which measures adjustment to pain from a
cognitive-behavioral perspective.
The following three distinct profiles emerged:
• (1) Dysfunctional, characterized by patients who
perceived the severity of their pain to be high, reported
that pain inter-fered with much of their lives, reported a
higher degree of affective distress, and maintained low
levels of activity
www.indiandentalacademy.com
45. • (2) Interpersonally distressed, characterized by a
common perception that 'significant others' were not very
understanding or supportive of the patient's problems;
and
• (3) Adaptive copers, patients with high levels of social
support, relatively low levels of pain perceived
interference, affective distress, and higher levels of
activity and perceived control.
www.indiandentalacademy.com
46. Dworkin and LeResche have developed a method for
assessing dysfunctional chronic pain as part of a
classification system, the Research Diagnostic Criteria.
They used the –
• Graded Chronic Pain Severity scale
• Depression and vegetative-symptom scales from the
Symptom Checklist-90-Revised (SCL-90-R)
• Jaw disability checklist.
www.indiandentalacademy.com
47. All three of these scales are based on questionnaires that
are completed by the patient.
• The Graded Chronic Pain Severity scale has four grades
of disability and pain intensity based on seven questions,
of which three are related to pain intensity and four are
related to disability.
• The SCL-90-R depression scales are used to identify
patients who may be experiencing significant
depression, a problem commonly associated with
chronic pain.
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48. Quantitative sensory technique
• Quantitative Sensory Testing (QST) is a set of sensory
tests based on normal and non-normal responses to
various non-invasive stimuli.
• QST modalities (thermal, mechanical, electrical, etc.)
selectively activate different sensory nerve fibers.
• Thin non-myelinated C fibres-Activated by heat stimuli.
• An important subset of C-fibres-responds to chemical,
mechanical, and thermal nociceptive stimuli.
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49. • A8(Delta) fibers have a thin myelinated sheath -
activated mainly by cold stimuli, fast-onset contact,
radiant (including laser) heat, and punctuate mechanical
stimulation, such as a pin.
• Aβ fibers have a thicker myelin coat -mediate touch and
vibratory sensations.
• Aα fibers - activated by pulsed electrical stimuli at the
threshold for detection.
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50. Three major levels of sensation can describe the response
to external sensory stimuli:
• Detection threshold
• Pain threshold
• Pain tolerance.
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51. • Employing QST as part of the routine OFP examination
can add to the sensory and pain evaluation.
• Hyperalgesia, for instance to heat stimulus, suggests
thin unmyelinated nerve fiber pathology, whereas tactile
hyperalgesia may suggest involvement of myelinated
fibers.
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53. I. The Chief Complaint
A. Location of pain
B. Onset of Pain
1) Associated with other
factors
2) Progression
C. Characteristics of pain
1) Quality of pain
2) Behavior of pain
a. Temporal
b. Frequency
c. Duration
1) Intensity
2) Concomitant symptoms
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54. D. Aggravating and alleviating factors
1) Physical modalities
2) Function and parafunction
3) Sleep disturbances
4) Medications
5) Emotional stress
E. Past consultation and/or treatments
F. Relationship to other complaints
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55. II. Past medical history
III. Review of systems
IV. Psychologic assessment
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56. A) Location of pain
• The patient's ability to locate the pain with accuracy is
diagnostic. It can be very helpful to provide the patient
with a drawing of the head and neck and ask him or her to
outline the location of the pain .
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57. • This allows the patient to reflect in his or her own way
any and all of the pain sites.
• The patient can also draw arrows revealing any patterns
of pain referral.These drawings can give the clinician
significant insight regarding the location and even the
type of pain the patient is experiencing.
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58. B) Onset of the Pain
• It is important to assess any circumstances that were
associated with the initial onset of the pain complaint.
• These circumstances can give great insight as to
etiology.
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59. • The onset of some pain conditions are associated with
trauma,systemic illnesses, or jaw function, or may even
be wholly spontaneous.
• It is important that the patient present the circumstances
associated with the initial onset in chronologic order so
that proper relationships can be evaluated.
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60. C) Characteristics of pain
1)Quality of the Pain.
• The quality of pain should be classified according to how
it makes the patient feel.
• This classification is usually termed
Bright –Stimulating and excitatory effect
Dull-Depressing effect
• Further evaluation of the quality of pain should be made
to classify it as –
pricking, itching, stinging, burning, aching, or pulsating.www.indiandentalacademy.com
61. 2)Behavior of the Pain.
The behavior of the pain should be evaluated according to-
a)Temporal behavior- reflects the frequency of the pain
as well as the periods between episodes of the pain. It
is classified as- Intermittent, Continuous and Recurrent
b)Duration –
• Momentary- if expressed in seconds
• Long lasting- If expressed in minutes,hours or a day
• Protracted- pain that continues from one day to the
next is said to be protracted.
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62. c) Localizability-
• Localized pain-site of pain easily localised by patient
• Diffuse pain-less well defined and vague pain
• Radiating pain-rapidly changing pain
• Lancinating pain-momentary cutting exacerbation
• Spreading-more gradually changing pain
• Enlarging-progressively involves adjacent anatomic
areas
• Migrating-changes from one location to another
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63. 3) Intensity of the Pain.
The intensity of pain can be-
• Mild pain-it is associated with pain that is described by
the patient but there is no display of visible physical
reactions.
• Severe pain- are associated with significant reactions
of the patient to provocation of the painful area.
• One of the best methods of assessing the intensity of
the pain is with a visual analog scale.www.indiandentalacademy.com
64. 4) Concomitant Symptoms.
• Sensations such as hyperesthesia, hypoesthesia,
anesthesia, paresthesia, or dysesthesia should be
mentioned.
• Any concomitant change in the special senses
affecting vision, hearing, smell, or taste should be
noted.
• Motor changes expressed as muscular weakness,
muscular contractions, or actual spasm should be
recognized.
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65. 5) Manner of Flow of Pain.
• Steady
• Paroxysmal
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66. D) Aggravating and Alleviating Factors
Effect of Functional Activities.-
• Trigerring pain- triggered by minor superficial stimulation
such as touch or movement of the skin, lips, face,
tongue, or throat.
• Induction pain- result of functioning of the joints and
muscles themselves.
• Can be differentiated by-Topical anaesthesia or a block-
Trigerring pain gets relieved while induction pain does
not.
• Parafunctional activities- bruxisism, clenching.www.indiandentalacademy.com
67. Effect of Physical Modalities- Effectiveness of hot or
cold on the pain condition.
Medications.
The patient should review all past and present
medications taken for the pain condition. Dosages
should be reported along with the frequency taken and
effectiveness in altering the chief complaint.
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68. Emotional Stress.
Emotional stress can be a major contributing factor to the
pain condition. Emotional stress may be a major factor or
an aggravating factor.
Sleep Quality.
Patients who report poor-quality sleep should be
questioned regarding the Relationship of this finding with
the pain condition.Particular notice should taken when the
patient reports waking during the night in pain or when the
pain actually wakes the patient.
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69. Litigation.
Important to inquire if the patient is involved in any form of
ligation related to the pain complaint. This information may
help the clinician better appreciate all conditions
surrounding the pain.
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70. E) Past Consultations and Treatments.
During the interview, all previous consultations and
treatments should be thoroughly discussed and reviewed.
This information is extremely important so that repetition of
tests and therapies is avoided.
F) Relationship to Other Pain Complaints
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71. II) Medical history
III) Review of Systems
IV) Psychological assessment
As pain becomes more chronic, psychologic factors relating
to the pain complaint becomes more common. Routine
Psychologic evaluation may not be necessary with acute
pain;however with chronic pain it becomes essential.There
are a variety of measuring tools to that can be used to
assess the psycological status of the patient.
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72. There are a number of psychologic conditions that can
contribute to or actual be responsible for the pain disorder.
For example-
• Somatiform disorders
• Conversion disorders
• Hypochondriasis
• Depression
• Anxiety disorders
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73. Summary of History
Once the history has been obtained, the clinician
should be able to accurately and completely
describe the pain condition.
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74. Clinical Examination
A. Vital signs
1) Blood pressure
2) Pulse rate
3) Respiration rate
4) Temperature
B. Cranial nerve evaluation
C.Eye evaluation
D.Ear evaluation
E. Cervical evaluation
F. Balance and coordination
I) General examination
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75. A)Vital signs-
Certain headaches may be associated with hypertension.
Systemic infections are often associated with elevated
body temperature. Increased breathing rates are often
associated with an upregulation of the sympathetic
nervous system. Therefore, blood pressure, pulse rate,
respiration rate, and body temperature should be
assessed especially when the pain condition is obscure.
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77. C) Eye Evaluation
• Pain felt in or around the eyes is noted as is whether or
not reading affects it.
• Reddening of the conjunctivae should be recorded along
with any tearing or swelling of the eyelids
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78. D) Ear evaluation
Hearing should be checked as in the eighth cranial nerve
examination. Infection of the external auditory meatus
(otitis externa) can be identified by simply pushing inward
on the tragus. If this causes significant pain, there could be
an external ear infection
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79. E) Cervical evaluation
• The mobility of the neck is examined for range and
symptoms.
• The patient is asked to look first to the right and then to
the left .
• There should be at least 70 degrees of rotation in each
direction.
• Next, the patient is asked to look up as far as possible
(extension) and then down as far as possible (flexion).
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80. • The head should normally extend back about 60 degrees
and flex down 45 degrees.
• Finally, the patient is asked to bend the neck to the right
and left . This should be possible to approximately 40
degrees each way.
• Any pain is recorded and any limitation of movement
carefully investigated to determine whether its source is
a muscular or a vertebral problem.
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81. F) Balance and coordination-
Tested by-
1) Touching nose with finger with eyes closed.
2) Walking along a straight line on the floor with the toe of
one shoe touching the heel of the other.
• Significant balancing problems can be quickly identified.
• The presence of a balance or coordination problem
should be assessed as to its relationship with the pain
disorder.
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82. II. Muscle examination
A. Palpation
1)Pain and tenderness
2)Trigger points and pain referral
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83. There is no pain associated with the normal function or
palpation of a healthy muscle. In contrast, a frequent
clinical sign of compromised muscle tissue is pain. The
degree and location of muscle pain and tenderness are
identified during direct palpation of the muscle.
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84. A) Palpation
A widely accepted method of determining muscle
tenderness and pain is by digital palpation. A healthy
Muscle does not elicit sensations of tenderness or pain
when palpated. Deformation of compromised muscle tissue
by palpation can elicit pain.
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85. To classify the degree of pain when a muscle is palpated, the patient's
response is placed in one of four categories.
• A zero (0) is recorded when the muscle is palpated and there is no
pain or tenderness reported by the patient.
• A number 1 is recorded if the patient responds that the palpation is
uncomfortable (tenderness or soreness).
• A number 2 is recorded if the patient experiences definite discomfort
or pain.
• A number 3 is recorded if the patient shows evasive action or eye
tearing or verbalizes a desire not to have the area palpated again.
A routine orofacial muscle examination includes palpation of the
following muscles or muscle groups:- temporalis, masseter,
sternocleidomastoid, and posterior cervical (eg, the splenius capitis
and trapezius).
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91. Trigger Points
• Trigger points are clinically identified as specific
hypersensitive areas within the muscle tissue.
• Often a small firm tight band of muscle tissue can be felt.
• Active trigger points represent a source of deep pain and
can therefore produce referred pain.
• Anaesthetic blocking of trigger point often eliminates the
referred pain and thus becomes a helpful diagnostic tool.
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92. III. Masticatory evaluation
A. Range of mandibular movement
1) Measurements
2) Pain
B. Temporomandibular joint evaluation
1) Pain
2) Dysfunction
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93. C. Oral structures
1) The mucogingival tissues
2) The teeth
3) The periodontia
4) The occlusion
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94. Masticatory Evaluation
An examination of masticatory muscles should include-
A) Range of mandibular movements-
• Normal interincisal opening-53-58mm.
• Maximum comfortable opening and maximum opening is
recorded. In absence of pain both the measurements are
same.
• Resticted mouth opening is anything less than 40mm.
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95. The path taken by the midline of the mandible during
maximum opening should also be observed.
• Deviation-It is usually due to a disc derangement in one
or both joints and is a result of the condylar movement
necessary to get past the disc during translation. Once
The condyle has overcome this interference, the straight
midline path is resumed.
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96. • Deflection-It is due to restricted movement in one joint.
Resticted movements of the mandible may be due to –
Extracapsular(related to muscles)
Intracapsular restrictions.(related to disc-condyle
function and the surrounding ligaments and thus are
usually related to a disc derangement disorder.)
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97. Testing end feel-
It describes the characteristics of the joint when an attempt
is made to increase mouth opening passively by gently
Placing downward force on the lower incisors with the
fingers to increase the interincisal distance.
• Soft end feel (increased opening can be achieved)-
muscle induced restriction.
• Hard end feel (increased opening cannot be achieved)-
associated with intracapsular sources.
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100. Temperomandibular joint evaluation
Pain or tenderness of the TMJs is determined by digital
palpation of the joints when the mandible is stationary and
during dynamic movement.
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102. Oral Structures
• The gingiva and entire oral mucosa should be tested by
touch, pinprick, and manual palpation to identify areas of
abnormal sensibility.
• Visual inspection of the superficial mucogingival tissues
of the mouth and throat is done to identify hyperemia,
inflammation, abrasion, ulceration, neoplasm, or other
abnormality.
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103. The teeth, especially on the side in question, should be
examined individually to obtain the following data:
1. Sensitivity or tenderness without provocation.
2. Sensitivity or tenderness due to occlusal function.
3. Sensitivity to touch, percussion, or probing with a dental
explorer.
4. Tenderness from pressure directed down the long axis of
the tooth.
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104. 5. Tenderness from pressure exerted laterally on the tooth.
6. Response to thermal shock (Warmth may be applied via
a heated instrument; chilling may be done by applying
ethyl chloride on a cotton applicator. The tooth should be
isolated with celluloid strips, especially when adjacent
metallic fillings are present or when covered with an
artificial dental crown.)
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105. 7. Response to electric pulp tester (Each tooth should be
isolated with celluloid strips, especially when adjacent
metallic fillings are present. Care should be taken to
differentiate between pulpal and gingival responses.
8. Radiographic evidence of pathologic change
9. Evidence of occlusal trauma
10. Evidence to justify direct exploration ofthe tooth
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106. IV. Other diagnostic tests
A. Imaging
B. Laboratory tests
C. Psychologic provocation tests
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107. A) Imaging-
• When painful symptoms arise from the orofacial
structures, radiographs of the teeth, sinuses, and
temporomandibular joints can be helpful.
• Radiographs of the TMJs will provide information
regarding the morphologic characteristics of the bony
components of the joint, and certain functional
relationships between the condyle and the fossa.
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108. • Another type of image that may have some usefulness in
identifying sites of pain is thermography. The crystals
change color in response to temperature gradients,
presumably due to altered blood flow in superficial
structures.
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109. B) Laboratory testing
• Medical laboratory testing may be needed to confirm a
diagnosis for some conditions such as rheumatoid
arthritis, psoriatic arthritis, and hyperuricemia.
• Blood studies may also be helpful in ruling out systemic
infections or other systemic conditions such as diabetes.
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110. C) Psychologic Provocation Tests
• 1) attempt to induce pain purely by suggestion.
• 2) trial placebo therapy
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111. Establishing the Pain Category
Once the history and examination have been completed,
the clinician should have a significant understanding of the
patient's pain complaint. The next step in diagnosis is
to place the pain complaint into the proper pain category.
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115. Proper category can be reached at by
answering the following questions
• 1) Is the Pain acute or chronic
• 2) Is the Pain Neuropathic or somatic
• 3) Is the Pain Primary or secondary
• 4) Is the Pain Superficial or deep.
• 5) Is the Pain Musculoskeletal or visceral
• 6) Is the Pain inflammatorywww.indiandentalacademy.com
116. Confirmation of the Clinical Diagnosis
Before undertaking definitive therapy, confirmation of the
clinical diagnosis is advisable.
There are four methods that can help confirm the
diagnosis:
• Diagnostic analgesic blocking
• Utilization of diagnostic drugs
• Consultations
• Trial therapy.
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117. Diagnostic analgesic blocking
• The value of local anesthetic injections and application of
topical anesthetics to identify and localize pain cannot be
overemphasized.
• It is essential when differentiating primary from
secondary pains.
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118. Diagnostic Drugs
• Confirmation of pain due to myocardial ischemia is
usually accomplished by using a testing dose of
nitroglycerin beneath the tongue.
• Discomfort of vascular and neurovascular pain disorders
seems to derive from the dilation and amplitude of
pulsation of the blood vessels involved, the diagnostic
use of medications that temporarily constrict blood
vessels may help confirm the diagnosis. For this
purpose, ergotamine tartrate is used and administered
as 0.5 to 1 mg of drug injected intramuscularly.
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119. Consultations
• There are occasions when pain problems require
medical, otolaryngologic, orthopedic, neurologic,
rheumatologic, or psychologic consultation for proper
identification of the pain disorder.
• It requires judgment, therefore, on the part of the
examiner to guide the patient through the examining
procedure that will arrive at a firm diagnosis in the most
direct, time-saving, and economic manner.
• Elaborate diagnostic and consultative procedures should
not be routine. Yet if the problem justifies it, every
avenue of exploration should be used to attain at a
confirmed working diagnosis.
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120. Trial Therapy
A short period of trial therapy is a good means of
confirming a diagnosis, provided the examiner is familiar
with the effectiveness of placebo therapy.
For Example-Trial therapy for muscular pains is useful
to help confirm the diagnosis. This includes the use of
vapocoolants, analgesic blocking of painful muscles,
controlled physical therapy, and the use of muscle
relaxants. If definite benefit accrues from such therapy, a
firm diagnosis of muscle pain becomes justified.
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121. Conclusion
Diagnosing a pain complaint consists essentially of three main steps-
• 1) Accurately identifying the location of the structure from which the
pain emanates.
• 2) Establishing the correct pain category that is represented in the
condition under investigation.This is a matter of recognizing the
clinical characteristics that are displayed.Establishing the proper
pain category is dependent on a good understanding of the genesis
and mechanisms of pain.
• 3) Choosing the particular pain disorder that correctly accounts for
the incidence and behaviour of the patient’s pain problem.this
requires familiarity with the clinical symptoms displayed by pain
disorders that occur in the orofacial region.
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130. • Trigger Points vs. Tender Points
• Trigger points Tender points
• Local tenderness, taut band, local Local tenderness
• twitch response, jump sign
• Singular or multiple Multiple
• May occur in any skeletal muscle Occur in specific
locations that are
• symmetrically located
• May cause a specific referred Do not cause referred
pain, but often cause
• pain pattern a total body increase in pain sensitivity
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