Subha Giri BDS MS Minnesota Head and Neck Pain Clinic

Transcription

1 Subha Giri BDS MS Minnesota Head and Neck Pain Clinic

2 1. Introduction 2. Classification of Orofacial pain disorders 3. Clinical Evaluation of the various Orofacial pain disorders 4. Differential diagnoses 5. Acute management of Orofacial pain disorders 6. Clinical case scenarios for review. (c) 2016 Subha Giri BDS MS 2

3 Orofacial pain disorders Orofacial pain is a frequent form of pain perceived in the face and/or oral cavity. It may be caused by diseases or disorders of regional structures, dysfunction of the nervous system, or through referral from distant sources (IASP 2013) Prevalence up to 22% of the general population. On an average, A patient with orofacial pain condition has been evaluated by three clinicians prior to arriving at an accurate clinical management of the condition. (c) 2016 Subha Giri BDS MS 3

4 Classification of Orofacial Pain Disorder Cutaneous and mucogingival pain Stomatitis, Recurrent aphthae, HSV, Burning mouth syndrome associated with xerostomia (dry mouth). Dental pain Dental abscess of pulpal origin, Periodontal disease and abscess, non dental referred toothache (sinus, cardiac, muscular referred pain). (c) 2016 Subha Giri BDS MS 4

5 Classification of Orofacial Pain Disorder Musculoskeletal pain Temporomandibular joint disorders, muscle spasm, myalgia and myofascial pain of the muscles of mastication. Neurovascular pain Migraine, Autonomic cephalalgia, cranial arteritis and carotidynia. Neuropathic pain cranial neuralgias, neuropathy with or without trauma, CRPS, Post herpetic neuralgias. (c) 2016 Subha Giri BDS MS 5

6 Clinical evaluation of Orofacial pain Vital signs and cranial nerve evaluation Vision and Ear evaluation and exclusion of infectious or inflammatory disease. Cervical evaluation with range-of-motion and pain referral. Palpation of the muscles of mastication and temporomandibular joints. Range of motion of the temporomandibular joints. (c) 2016 Subha Giri BDS MS 6

7 Clinical evaluation of Orofacial pain Muscle palpation -Temporalis -Masseter -Sternocleidomastoid -Splenius Capitis -Trapezius -The medial and lateral pterygoid referral region. (c) 2016 Subha Giri BDS MS 7

8 Clinical Evaluation Range of Mandibular Movement a. Average mandibular range of motion inter incisally is at least 40 mm. b. open slowly until pain is first felt ; open slowly to the maximum. c. Mandibular deviation and deflection. (c) 2016 Subha Giri BDS MS 8

9 Clinical Evaluation TMJ evaluation a. Palpation of the lateral aspect of the joints simultaneously. b. Palpating the lateral poles of condyles with medially directed force. c. Scored on 0-3 scale, similar to muscle palpation. d. With mouth opening, posterior aspect of condyle is palpated. (c) 2016 Subha Giri BDS MS 9

10 Clinical Evaluation TMJ evaluation a. Joint noises a. Clicking - single sound of a short duration b. Crepitation - multiple gravelling like sound b. Joint noises evaluated with palpation and auscultation. (c) 2016 Subha Giri BDS MS 10

11 Clinical Evaluation Evaluation of oral structures Gingiva - inspection, touch, palpation Teeth - inspection, palpation, percussion Spontaneous pain Pain on touch, percussion or occlusion. Hot and cold sensitivity Occlusal comfort (c) 2016 Subha Giri BDS MS 11

12 Cutaneous and mucosal pain disorders Intra oral lesion with or without pain Acute onset Presence of Prodromal symptoms for infectious mucosal conditions. (c) 2016 Subha Giri BDS MS 12

13 Musculoskeletal Orofacial Pain disorders a. New onset spontaneous pain in the preauricular region b. Limitation or restriction in mandibular range of motion restricted mouth opening. c. Painful jaw joint noises of clicking or crepitation (c) 2016 Subha Giri BDS MS 13

14 Neuropathic Orofacial Pain Disorders Paroxysmal sharp, electric pain of moderate to severe intensity, presenting unilaterally along the distribution of a cranial nerve. Continuous, unilateral or bilateral, dull burning pain with or without recent history of dental/orofacial surgical or non surgical trauma. Absence of local infectious or inflammatory disease upon clinical evaluation (c) 2016 Subha Giri BDS MS 14

15 Neurovascular Orofacial Pain disorders Concurrent presentation of headache not sufficiently treated with gold standard headache management. Headache duplicated with the palpation of orofacial structures particularly the TMJs and Muscles of mastication Abnormal Lab with elevated sed rate for Arteritis. (c) 2016 Subha Giri BDS MS 15

16 Differential diagnoses Could this be Orofacial pain? Ear pain TMJ disorders, Myalgia and masticatory myofascial pain Sinus pressure TMJ disorders, myalgia and masticatory myofascial pain, trigeminal neuralgia and neuropathy. Headache TMJ disorders, Masticatory myofascial pain, neuralgia and neuropathy. (c) 2016 Subha Giri BDS MS 16

17 Preliminary treatment plan Self-care Medications NSAIDs, Muscle relaxants. Imaging Panoramic radiograph, CT TMJ, MR TMJ, MR Brain. Physical therapy, Cognitive Behavioral therapy, medication management, oral appliance therapy. (c) 2016 Subha Giri BDS MS 17

18 Thank you! (c) 2016 Subha Giri BDS MS 18