Oral Medicine Orofacial Pain Important Notes
1. Trigeminal neuralgia/ Fothergiirs disease
- Characterized by stabbing or lancinating pain
- Initiated by touching the trigger zones
- These are the vermillion borders of the lip, around the eyes, ala of nose
2. Drugs used in the treatment of trigeminal neuralgia
- Gabapentin
- Pregabalin
- Oxycarbamazepine
- Phenytoin
- Lamotrigine
- Topiramate
- Pimozide
3. Dose of carbamazepine for trigeminal neuralgia
- Initial dose – 200 mg/day
- Increased to 800-1200 mg/day
4. Bell’s palsy
- Manifests as
- Drooping of the corner of the mouth
- Drooling of saliva
- Watering of eye
- Inability to blink
- Patient as an expressionless face
- Speech difficulty
- Loss of taste in the anterior part of the tongue
5. Frey’s syndrome
- Occurs due to damage of the auriculotemporal nerve following surgery in the parotid or mandibular ramus area
- The patient exhibits flushing and sweating of the involved side of the face
6. Migraine
- It is the most common vascular headache
- Causes pain of the face and jaws
- Occurs due to vasoconstriction of intracranial vessels followed by vasodilation
- Basilar migraine is common in young women
- Drugs used are: ergotamine and sumatriptan
Read And Learn More: Oral Medicine Question and Answers
7. Cluster headache
- It is unilateral
- Most painful of all headaches
- Periorbital pain is common
- Associated with homolateral lacrimation
Oral Medicine Orofacial Pain Long Essays
Question 1. Write a differential diagnosis of orofacial pain. Write a note on the etiology, clinical features, and management of idiopathic trigeminal neuralgia.
OR
Define pain. Describe trigeminal neuralgia including its management.
Answer:
Trigeminal Neuralgia Definition:
Pain is an unpleasant emotional experience initiated by noxious stimuli and transmitted over the specialized neural network to CNS
Orofacial Pain:
- Differential diagnosis
Trigeminal Neuralgia Extracranial Causes:
- Dental and oral
- Dentinal hypersensitivity
- Pain due to pulpal disorders: hyperemia
- Pain due to periodontium disorders
- Mucogingival pain: gingivitis
- Osseouspain: dry socket
- Pain from paranasal sinuses
- Musculoskeletal: eagle’s syndrome
Trigeminal Neuralgia Intracranial Causes:
- Disorders of pain receptors
- Neoplasms
- Edema
Trigeminal Neuralgia Vascular Causes:
- Migraine headache
- Tension headache
- Neurogenic Pain:
- Syndrome Associated: Reiter’s syndrome
- Psychogenic Pain: Anxiety
Idiopathic Trigeminal Neuralgia:
- Etiology:
- Pathological
- Environmental
- Dental pathosis -Allergic
- Traction on divisions of the trigeminal nerve.- Irritation to the ganglion
- Ischaemia – secondary lesions
- Aneurysm of internal carotid artery
Trigeminal Neuralgia Clinical Features:
- Age: around 35 years
- Sex: common in female
- Site: right lower portion of the face, usually unilateral
- Duration: a few seconds to a few minutes
- As time passes duration between the cycles decreases
- Nature: stabbing or lancinating
- Aggravating factors: activation of Trigger Zones
- These are the Vermillion border of the lip, around the eyes, ala of nose
- Interference with other activities:
- The patient avoids shaving, washing their face, chewing, and brushing, as these may aggravate pain
- These lead to a poor lifestyle
- Extreme cases: leads to “Frozen Or Mask Like Face”
Trigeminal Neuralgia Management:
1. Medical:
- Carbamazepine: initial dose:100mg twice daily until relief is achieved
- Dilantin: 300-400mg in single or divided doses
- Combination therapy: dilantin + carbamazepine
2. Surgical:
- Injection of alcohol in gasserian ganglion
- Nerve avulsion: performed on the lingual, buccal or mental nerve
- Part of the nerve is sectioned
- Electrocoagulation of gasserian ganglion: diathermy is done
- Rhizotomy: Trigeminal sensory root is sectioned
- Newer technique: Tens
- Low-intensity current is used at high frequency is applied to the skin through electrodes attached by a conduction paste
Oral Medicine Orofacial Pain Short Essays
Question 1. Bell’s palsy.
Answer:
Bell’s palsy
- Idiopathic paralysis of the facial nerve of sudden onset
Etiology: 5 Hypothesis:
- Rheumatic
- Cold
- Ischaemia
- Immunological
- Viral
Bell’s palsy Clinical Features:
- Pain in post auricular region
- Sudden onset
- Unilateral loss of function
- Loss of facial expression
- Absence of wrinkling
- Inability to close the eye
- Watering of eye
- Inability to blow the cheek
- Obliteration of nasolabial fold
- Loss of taste sensation
- Hyperacusis
- Slurring of speech
Bell’s palsy Management:
1. Physiotherapy:
- Facial exercises
- Massaging
- Electrical stimulation
2. Protection to eye
- Covering of eye with a bandage
3. Medical management
- Prednisolone – 60-80 mg per day
- 3 tablets for 1st 4 days
- 2 tablets for 2nd 4 days
- 1 tablet for 3rd 4 days
4. Surgical treatment
- Nerve decompression
- Nerve grafting
Question 2. Atypical facial neuralgia.
Answer:
It refers to a mixed group of conditions which are defined and diagnosed by the exclusion of other typical patterns of facial pain
Atypical facial neuralgia Clinical Features:
- Age and sex: More common sixth-decade women
- Features:
- Deep, poorly localized pain
- Pain is often boring, pressing, burning, pulling or aching
- Pain is constant
- Pain is referred to the temple, neck, and occipital area
- The mucosa of the affected area may contain a zone of increased temperature and bone marrow activity
Atypical facial neuralgia Management:
- Opioid analgesic:
- Tricyclic antidepressants like amitriptyline
- Psychotherapy
- Behavior modification
- Transcutaneous electrical nerve stimulation
- Sympathetic nerve block
Oral Medicine Orofacial Pain Short Answers
Question 1. Bell’s sign.
Answer:
Bell’s sign
- Seen in Bell palsy
- The inability to close the eye occurs in it
- On attempting to close the eye, the eyeballs roll upwards
- This peculiar sign is called “Bell’s Sign”
Question 2. TENS therapy.
Answer:
TENS therapy
- It is one of the popular forms of pain control
- It employs low-intensity current at a high frequency of 50 to 100 Hz
- It is applied to the skin via electrodes attached by a conduction paste
- It is used to stimulate nonnociceptive cutaneous afferent neurons that activate descending pain inhibition mechanism without involving opioid peptides
- The analgesic effect ranges from 50 to 70%
Question 3. Classification of headache.
Answer:
Classification Of Headache:
- Migraine headache
- Tension-type of headache
- Cluster headache
- Miscellaneous headache
- Traumatic headache
- Headache due to vascular causes- hematoma
- Headache due to nonvascular causes- due to increased pressure
- Headache due to substance abuse- alcohol
- Headache due to systemic infection
- Headache due to metabolic disorders
- Headache due to referred pain- from ear, etc.
- Cranial neuralgia- trigeminal neuralgia
- Unclassified headache
Question 4. Alarm clock headache.
Answer:
Alarm clock headache
- It is a feature of sphenopalatine neuralgia
- Its attack develops regularly
- Usually, it develops once at day time over a prolonged period
- Some patients experience it at the same time daily
- Thus it is referred to as an alarm clock headache
Oral Medicine Orofacial Pain Viva Voce
- Herpetic inflammation of 7 cranial nerves leads to geniculate neuralgia
- Conjunctival reddening is observed in cluster headache
- Cluster headache is triggered by smoking
- Post-herpetic neuralgia can be treated by analgesics and tricyclic antidepressants
- Auriculotemporal nerve damage leads to Frey’s syndrome
- Pain in trigeminal neuralgia occurs on touching the trigger zones
- Cluster headache is the most painful of all headaches
- Carbamazepine is drug of choice in trigeminal neuralgia