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 washin face/shaving etc. treat by carbamazepine 100mg 2x day - LA injected to trigger zone can relief pain temporarily
Glossopharyngeal neuralgia
posterolateral tongue + ear of affected side; stimuli -> eating, drinking, speaking
Preherpetic neuralgia - aching, burning pain, limited to distribution of CN 5, high dose acyclovir
Postherpetic neuralgia - unpleasant burning pain, LA blockade of stellate ggl with bupivicaine (short term relief)
Pain of vascular origin
migraine - intense persisting aching pain, unilateral; stimuli -> food, alcohol, stress, hormones, 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, high dose prednisolone to treat
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
