Murphy Managing Orofacial Pain in Practice

1. Auflage 2019
ISBN: 978-1-85097-328-7
Verlag: Quintessence Publishing Co. Ltd.
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band 37, 160 Seiten

Reihe: QuintEssentials of Dental Practice

The concept of pain management has evolved over the last 50 years. It encompasses several medical disciplines and has now become a distinct dental entity. This book explores the diagnostic techniques and management philosophies for common orofacial pain complaints; the different causes of orofacial pain like bruxism are presented.

Autoren/Hrsg.

Murphy, Eamonn

Inhaltsverzeichnis

Chapter 01: Orofacial Pain: An Introduction
Chapter 02: Assessment of the Patient with Orofacial Pain
Chapter 03: TMJ Disorders
Chapter 04: Bruxism and the Use of Splint Therapy
Chapter 05: Muscle-related Problems
Chapter 06: Neuropathic Orofacial Pain
Chapter 07: Neurovascular Orofacial Pain
Chapter 08: Addressing Key Psychological Factors in Orofacial Pain
Chapter 09: Patients with Complex Pain
Chapter 10: Case Presentations

Leseproben

Chapter 1
Orofacial Pain: An Introduction
Aim
The aim of this chapter is to discuss controversies associated with chronic orofacial pain (OFP). Outcome
Having read this chapter the practitioner should: appreciate the multiple sources of OFP and the frequency of presentation understand the differences between acute and chronic OFP appreciate the model used in the management of OFP. What Constitutes an Orofacial Pain Complaint: Classification Issues
The OFP conditions comprise a group of acute and chronic pain states that affect the mouth and face. The majority of those affected will attend a dentist; however, only some OFPs are related to the teeth. The diagnosis of OFP may prove to be one of the most challenging and frustrating problems faced by the dental practitioner. In an ideal world, patients would present with complaints with their own signature characteristics. This is rarely the case. In many instances, there is a significant overlap in the presentation of OFP conditions. An important distinction that should be made when dealing with OFP conditions is whether the pain is acute or chronic. In general, chronic OFP conditions have been present for three months or longer. A variety of classifications have been developed to represent the multitude of pain states that may present as OFP. These have evolved through the American Academy of Orofacial Pain, the International Headache Society and the International Association for the Study of Pain. Although there has been tremendous progress in this area since the 1980s, further work is required to provide a universal classification system. A simple classification system of OFP conditions is set out in Table 1-1. Table 1-1 Classification of orofacial pain Source Types Intraoral Dental Periodontal Extraoral Salivary Sinus Lymphatic Cardiac Pulmonary Musculoskeletal Temporomandibular joint Musculature Neuropathic Episodic: trigeminal neuralgia Continuous: trigeminal neuropathy/atypical odontalgia, post-herpetic neuralgia Neurovascular Tension type Migraine Cluster Psychological How Common is Orofacial Pain?
The commonest form of OFP that a dental practitioner encounters is toothache. A national study conducted in the USA showed that the overall prevalence of toothache in adults in the six months leading up to the study was 12.2%. In addition, this study estimated that 22% of the general population experienced OFP in any given six-month period. The commonest form of chronic OFP that a dentist will encounter is temporomandibular disorders (TMD). Population-based studies reveal that the rate of TMD is 8–15% in females and 3–9% in males. Incidence-based studies show that there are approximately two to four new cases of TMD per 100 people per annum. This contrasts to the incidence of trigeminal neuralgia, which has been estimated to be in the order of three to five new cases per 100,000 people per annum. The prevalence of chronic pain following successful endodontic treatment in a tertiary referral endodontic centre was 12%. The few epidemiological studies carried out on the general population estimated the prevalence of cluster headache to be 0.1%. In contrast, similar studies have estimated migraine prevalence to be approximately 18% for women and 6% for men. Therefore, when a patient presents complaining of OFP, it should be considered to be of dental origin until proven otherwise. When a dental component is not identified, non-dental sources must then be considered. The Stigmatisation of the Patient with Orofacial Pain
When a patient presents complaining of pain and the source of the pain cannot be readily identified, or dental intervention does not eliminate the complaint, questions are often asked regarding the psychological state of the patient (Fig 1-1). This has given rise to situations where patients are unfairly labelled as “psychogenic”, or their pain is described as “psychogenic” pain. The vast majority of OFP conditions have a legitimate cause; however, dentists are sometimes not in a position to diagnose the problem accurately. Fig 1-1 The stigmatisation of the patient with orofacial pain. Take, for example, a patient presenting with a cluster headache. A dentist may never come across such a problem. An accurate diagnosis is, therefore, unlikely. Furthermore, how many practitioners competently palpate the masticatory jaw muscles to rule out a muscular cause of OFP, even though muscle-related TMD is far commoner than joint-related TMD. What is essential is that the practitioner can rule out the common OFP possibilities in the primary dental setting. If this does not eliminate the pain, referral to the most appropriate centre for further investigation is necessary. Common reasons for referring an OFP patient for further investigation include: a diagnosis cannot be made following a comprehensive examination the patient has already attended multiple healthcare providers or undergone multiple interventions without an improvement the pain is out of proportion for common OFP complaints the patient has a complex medical history poor compliance with treatment prominent psychosocial factors contributing to the ongoing pain. Who Should Treat the Patient with Orofacial Pain?
The majority of patients complaining of OFP will attend their dentist. Most acute OFP complaints will be successfully treated by a dental practitioner; however, chronic OFP poses special problems requiring specific treatment strategies. The gold standard approach for treating chronic OFP is identical to that used in the management of chronic low-back or neck pain. The chronic pain model is not as familiar to dentists as the acute pain model. When a patient presents complaining of an acute dental abscess, for example, the source of the pain is identified and eliminated by extraction or root canal therapy. This generally eliminates the pain and resolves the problem. The same approach cannot be adopted, however, with a variety of chronic OFP conditions, including musculoskeletal or neuropathic OFP. When faced with a chronic OFP disorder, pain management is of utmost importance (Fig 1-2). Fig 1-2 The controversy surrounding who should treat chronic orofacial pain conditions. Initially, it is critical for a successful outcome to educate the patient to shift the focus from “curing” the condition to “managing” the complaint. Successful management of a chronic temporomandibular joint (TMJ) disorder can result in a patient having minimal or no pain, but this does not...