Facial Pain

• most important for diagnosing facial pain?

  history taking
• take a history:

  • location
  • character
  • duration
  • frequency and periodicity
  • precipitating, aggravating and relieving factors
  • associated features
• associated features of facial pain?

  swelling, nasal stuffiness
• odontogenic pain?

  • pain related to teeth
  • most common
  • acute or chronic
• what might cause otontogenic pain?

  • exposed dentine from recession, erosion and abrasion
  • caries once in dentine - sugar/hot/cold
  • pulpitis - painless or severe
• reversible pulpitis can resolve with a sedative dressing
• sequelae of apical periodontitis:

  • periapical granulome
  • apical periodontal cyst
  • periapical abscess
  • osteomyelitis
• Cracked tooth syndrome

  • pain on biting
  • fractured cusp
  • pulpitis
  • periodontitis
  • tooth sleuth for diagnosis (bite stick)
• occlusal trauma:

  • usually following restoration
  • sensitive to hot/cold
  • mobility
  • V-shape widening of perio ligament (on rads)
• Perio abcess

  • well localised
  • drain via perio ligament
  • dull continuous ache
  • pocketing
  • pain on pressure
  • pulp vital
  • localised odema
  • mobility
• ANG

  • pain on chewing
  • malaise
  • ulcers
  • lymphadenopathy
  • halitosis
• pericoronitis

  • erupting teeth
  • trismus
  • trauma from opposing teeth
  • flush area
  • antibiotics (avoided)
• chronic facial pain with no dental cause?

  Lancinating pain?

  • yes - trigeminal neuralgia
  • no - Atypical facial pain, oral dysaesthesia, referred pain, TMJ pain or postherpetic pain
• Lancinating pain?

  Electric shock like
• local causes of facial pain?

  • infection
  • trauma
  • malignancys
  • pagets disease
  • sinus disease
  • salivary gland disorder
• if not infected retained roots, impacted teeth and cysts rarely cause pain
• pagets disease?

  Paget's disease of bone disrupts the normal cycle of bone renewal, causing bones to become weakened and possibly deformed, symptoms including bone/joint pain
• malignant tumours?

  deep pain, associated with anaesthesia or paraesthesia
• benign tumour of bone?

  usually no pain - possible lip tingling or numbness can indicate tumour of jaw bone
• TMJ pain?

  • dysfunction
  • trauma
  • inflammation
  • rarely tumour
• TMJ dysfunction syndrome:

  • common
  • pain
  • click, lock jaw or limited opening
  • caused by over opening, bruxism, clenching, anxiety and stress
• management of TMJ pain:

  • reassure/explain benign and self limiting
  • rest/stress management
  • anti-inflammatory analgesic
  • occlusal splint
  • local physiotherapy
• eg of analgesic for TMJ pain-dysfunction?

  ibuprofen 400mg 3 x day
• neurological causes of facial pain?

  • trigeminal facial pain
  • sinus pain
  • migranes
  • cluster headaches
  • tension headaches
• persistent idiopathic facial pain?

  • atypical facial pain
  • no physical signs
  • used when organic disease is excluded
  • 1-2% population
  • middle aged +
  • extreme stress
  • contant chronic oral facial pain
• when can we exclude all organic diseases and refer to facial pain as persistent idiopathic facial pain?

  • total lack of objective signs
  • negative result to all investigations
  • no clear explanation
  • poor response to tx