Surgery

• Pain


  Unpleasant emotional feeling due to either physical or psychological trauma
• Acute pain


  Short duration, moderate to severe in severity, may not be relieved by mild analgesics
• Chronic pain


  Long duration (4 to 6 months), mild to moderate in severity, often associated with feelings of depression
• Classification of Orofacial Pain

  • Typical Orofacial Pain
  • Psychogenic Orofacial Pain
  • Vascular Orofacial Pain
  • Neuralgia
• Typical Orofacial Pain


  • Dental
  • Periodontal
  • Mucosal
  • Bone
  • Salivary gland
  • Temporo-Mandibular Joint
  • Maxillary sinus
• Psychogenic Orofacial Pain


  • Facial arthromyalgia
  • Atypical facial pain
  • Atypical odontalgia
  • Oral dysthesia
  • Factitious ulceration
• Vascular Orofacial Pain


  • Migraine
  • Cluster headache
  • Giant cell arteritis
• Neuralgia


  • Primary neuralgia
  • Secondary neuralgia
• Primary neuralgia


  • Trigeminal neuralgia
  • Glossopharyngeal neuralgia
• Secondary neuralgia


  • Extra cranial lesions
  • Cranial base lesions
  • Intracranial lesions
• Extra cranial lesions


  • Two mental nerves neuralgia
  • Causalgia
  • Frey's auriculotemporal syndrome
  • Herpes zoster
  • Post herpetic neuralgia
  • Nasopharyngeal carcinoma
• Cranial base lesions


  • Petrous Temporal osteitis
  • Cholesteatoma
• Intracranial lesions


  • Posterior cranial fossa
  • Middle cranial fossa
  • Multiple sclerosis
• Other Orofacial Pain (Referred pain)


  • Ocular
  • Cardiac
  • ENT
  • Elongated styloid process
• Painful disorders of the maxillofacial region, whether neurologic or musculoskeletal, are common reasons for obtaining a dental opinion
• It is critical for dentists to become knowledgeable about facial neuropathologic conditions
• The different structures in the head and neck region make an accurate diagnosis challenging
• Diagnosing pain


  1. Take history carefully if no detectable sign

  2. Send patient for more investigations if there are associated signs
• Visual Analogue Scale and Verbal Rating Scale

  Methods used to document the symptoms severity described by the patient and classify pain severity and disease control
• Information to take in history

  • Character of the pain
  • Severity of the pain
  • Site and radiation of pain
  • Timing: frequency and duration
  • Provoking factors
  • Relieving factors
  • Associated clinical features
  • Pain elsewhere in the body
  • General medical history
  • Patient's emotional history
  • Family history
• Somatic pain


  Arises from musculoskeletal or visceral structures interpreted through an intact pain transmission and modulation system
• Neuropathic pain


  Arises from damage or alteration to the pain pathways, most commonly a peripheral nerve injury due to surgery or trauma
• Psychogenic pain


  Tension headache occurs as a result of stressful life, anxiety, neurosis or depression
• Dental pain (odontalgia)


  • Pulpitis presented as transient dull or sharp pain provoked by thermal changes, may be well localized or diffuse/referred, associated with carious or filled tooth, acute pulpitis and periapical abscess are tender to percussion
• Treating dental pain


  Amalgam or composite filling, RCT, or extraction of unrestorable tooth
• Periodontal pain


  • Periodontitis presented as continuous dull pain initially relieved by clenching the teeth, later aggravated by this action, associated with gum recission, exposed root, pocket, or tooth mobility
• Treating periodontal pain


  Acute periodontal abscess treated by drainage of exudates and antibiotic, then periodontal surgery (root planning and curettage) when acute phase has subsided
• Odontogenic tumors are pathologic outcomes from tissue elements that are part of the tooth-forming apparatus, that is, odontogenic tissues
• Odontogenic tumors occur exclusively in the bones of the jaw particularly around the teeth-bearing segments
• Mucosal pain

  • Traumatic ulceration, aphthous stomatitis, viral ulceration, erosive lichen planus, causing burning sensation provoked by spicy or hot food
• Patients with odontogenic tumors usually present with symptomatic or asymptomatic swelling in the oral and maxillofacial region
• Most of these swellings have either tooth-associated symptoms or tooth-associated radiological changes
• Investigating mucosal pain

  Biopsy if ulcer persists for more than two weeks
• General dentists serve as the preliminary point of patient contact and see patients on a regular basis, so it is imperative that they become familiar with the recognition and diagnosis of odontogenic tumors
• Treating mucosal pain

  Each condition requires specific therapy
• Odontogenic tumors comprise neoplastic growths of benign, malignant, or tumor-like malformations originating from odontogenic tissues
• The interactions between ectodermal and mesenchymal elements from odontogenic tissues can initiate tumor formation due to disturbance in signaling mechanism for their growth and proliferation
• Bone pain

  • Alveolar osteitis (dry socket), fracture, osteomyelitis and tumor causing continuous dull ache to severe throbbing
• Investigating and treating bone pain

  1. ray and biopsy, then analgesic and antibiotic or surgery
• WHO classification of odontogenic and maxillofacial bone tumors (5th edition, 2022)

  • Benign epithelial odontogenic tumours
  • Benign mesenchymal odontogenic tumours
  • Benign mixed epithelial and mesenchymal odontogenic tumours