Orofacial Pain Question And Answers

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

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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‚Äôs 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

Vascular Causes

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:

  1. Migraine headache
  2. Tension-type of headache
  3. Cluster headache
  4. Miscellaneous headache
  5. Traumatic headache
  6. Headache due to vascular causes- hematoma
  7. Headache due to nonvascular causes- due to increased pressure
  8. Headache due to substance abuse- alcohol
  9. Headache due to systemic infection
  10. Headache due to metabolic disorders
  11. Headache due to referred pain- from ear, etc.
  12. Cranial neuralgia- trigeminal neuralgia
  13. 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

  1. Herpetic inflammation of 7 cranial nerves leads to geniculate neuralgia
  2. Conjunctival reddening is observed in cluster headache
  3. Cluster headache is triggered by smoking
  4. Post-herpetic neuralgia can be treated by analgesics and tricyclic antidepressants
  5. Auriculotemporal nerve damage leads to Frey’s syndrome
  6. Pain in trigeminal neuralgia occurs on touching the trigger zones
  7. Cluster headache is the most painful of all headaches
  8. Carbamazepine is drug of choice in trigeminal neuralgia

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