Facial Pain

Primary causes of pain

• Dentine sensitivity
• pulpitis
• periapical periodontitis
• abscess
• neuralgias

Neuralgias

• Trigeminal neuralgia

Sharp stabbing episodic electric shock like pain; lasts a few sec

Trigger zone - stimulated by washing face/shaving etc.

Treated with carbamazepine 100mg 2x per day. Local anesthetic, injected to trigger zone can relief pain temporarily

• Glossopharyngeal neuralgia

Posterolateral tongue and ear of affected side

stimuli : eating, drinking, speaking

• Preherpetic neuralgia

Aching, burning pain, limited to distribution of trigeminal nerve

Treated with high dose acyclovir

• Postherpetic neuralgia

Unpleasant burning pain.

Blockade of stellate ganglion with bupivicaine (local anesthetic) (short term relief)

Pain of vascular origin

• migraine

Intense persisting aching pain, unilateral

Stimuli : food, alcohol, stress, hormones.

We give painkillers.

• Cluster headache

Intense aching pain that disturbs sleep, nasal congestion.

Stimuli : alcohol, vasodilators, high altitude.

Treat with ergotamine or sumatriptan.

• Giant cell Arteritis

Throbbing headache, unilateral, fever, malaise, weight loss

Treated with high dose prednisolone.

Atypical orofacial pain

Gripping, vice like aching pain, feeling of pressure

Burning mouth syndrome

• type 1 (not present on waking)
• type 2 (present on waking)
• type 3 - intermittent - Possible deficiency of vitamin B1 and B6