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EVALUATION OF OROFACIAL PAIN PATIENT
Evaluation of the dental patient who presents with jaw or face pain of nonodontogenic origin is an important skill for the dentist to master. Obtaining an accurate history is the most important component of information gathering.For chronic headache disorders and many neuropathic disorders, such as TN, pre-TN, and other cranial neural–
.glas, as well as burning mouth
Indomethacin-Responsive Headaches
A number of head pains respond primarily ‘or exclusively to the NSAID, indomethacin. One of these headaches, chronic paroxysmal hemicrania, is similar In presentation to cluster headache, although the attacks are short
lived (lasting several minutes) and occur manytimes per day. Unlike clust-er headaches, women are more often affected than men: Again toothache may be the
Cluster Headache
Cluster headache is an overwhelmingly unilateral head pain typically centered around the eye and temporal regions. The pain is’ intense, frequently described as a stabbing sensation (i.e., as if an ice pick was being driven into the eye). Some component of parasympathetic overactivity
is present (commonly lacrimation, conjunctival injection, ptosis, or rhinorrhea). Headaches last 15 to 1
Tension-Type Headache
The majority of patients who report to the physician with a chief complaint of headache will be diagnosed with tension-type headache, The’ name can be misleading ecause “muscle tension” or “tension from stress” is not
always present, either alone or in combination. Tensiont}pe headache is common in the general population, and most people will experience at leas
Neuropathic Facial Pains Presenting as Toothache
Glossary of Pain Terms
Allodynia Pain caused by a stimulus that does
not normally’ provoke pain
Absence of pain in response to
stimulation that would normally be
painful
Absence of all sensation
, ‘Pain caused by loss of sensory input
into the central nervous system
(eNS)
Unpleasant abnormal sensation,
whether spontaneous or evoked
(Note: Dysesthesia incl
NEUROPATHIC FACIAL PAINS
Neuropathic pains arise from an injured pain transmission or modulation system, Surgical intervention or trauma is frequently the cause, For example, trauma to the infraorbital region may lead to numbness or pain in the . distribution of the infraorbital nerve. In oral and maxillofacial surgery, extraction of mandibular third molars carries a slight but measurable risk of nerve damage
CLASSIFICATION OF OROFACIAL PAINS
Numerous classification systems exist for orofacial pain conditions. At the most basic level, it is appropriate to classify orofacial pains as primarily somatic, neuropathic, or psychologic in or.igin. SOli/atic pain arises from musculoskeletal or visceral structures interpreted through an intact pain transmission and modulation system. Common orofacial exampres
of musculoske
C’HAPTER OUTLINE
BASICS OF PAIN NEURQPHYSIOLOGY
CLASSIFICATION OF OROFACIAL PAINS
NEUROPATHIC FACIAL PAINS
Neuropathic Facial Pains Presenting as Toothache
Trigeminal Neuralgia ‘
Pretrigeminal Neuralgia
Odontalgia Secondary to Deafferentation (Atypical
Odontalgia)
Other Neuropathic Fadill Pains
Postherpetic Neuralgia
Neuroma
Burning Mouth Syndrome
Other Cranial Neuralgias
CHRONIC HEADACHE •
Migraine
T