facial pain university of palestine非典型面部疼痛的巴勒斯坦大学课件

atypical facial pain SYMPTOMS Facial pain, often described as burning, aching or cramping, pulling, occurs on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp. Although rarely as severe as trigeminal neuralgia, facial pain is continuous for ATFP patients, with few, if any periods of remission. DIAGNOSIS Diagnosing atypical facial pain is not an easy task. Its not unusual for ATFP patients to have undergone numerous dental procedures, seen multiple doctors and undergone many medical tests before being successfully diagnosed and treated. A diagnosis of ATFP is usually a . When a patient complains of process of elimination constant facial pain restricted to one side of the face, the physician must first rule out any other conditions. Tests include roentgenograms of the skull, MRI and/ or CT scan with particular attention to the skull base, careful evaluation, and thorough otolaryngolgicdental and neurological examination. Only after tests rule out other factors can a diagnosis of ATFP be made. TREATMENTS Treatment of ATFP can be difficult and perplexing for both doctor and patient. Medication is usually the first course of treatment. decompression microvascularSurgical procedures such as generally are not successful with ATFP patients. The following drugs are used to treat atypical facial pain: )Elavil, Triptyl. (Amitriptyline ).Neurontin. (Gabapentin Pamelor Capsaicin Other pain relief strategies include: Hot and cold compresses Acupuncture odontalgiaAtypical describes atypical facial pain odontalgiaAtypical in apparently normal teeth. Unfortunately, dentists usually consider this diagnosis only after the failure of invasive treatment. Atypical women in patients are typified by odontalgia their mid-40s who complain of persistent pain in . They one or more premolar or molar teeth associate pain with dental procedures or trauma to the region, While the cause of atypical is uncertain.odontalgia Patients with unrelenting pain in the teeth, often see gingival, palatal or alveolar tissues multiple dentists and have multiple irreversible procedures performed and still have their pain. Up to one-third of patients attending a chronic facial pain clinic have undergone prior irreversible dental procedures for their pain without success. In these cases, if no local infectious, inflammatory, or other source of differential can be found, then the pathology pain neuropathicdiagnosis must include a focal disorder. , odontalgiaThe common diagnoses given include the terms atypical pain, or if teeth have been extracted, phantom orodentalpersistent One possibility is that these pain complaints are due to a tooth pain. . There are several alteration of the trigeminal nerveneuropathic that need to be performed in any patient diagnostic procedures disorder including (1) neuropathicsuspected of having a trigeminal periapical; (2) a nonvitality pulpalcold testing of involved teeth for radiograph examining the teeth for apical change; (3) a panoramic radiograph examining for other maxillofacial disease; (4) a thorough head and neck examination also looking for abnormality; (5) a cranial nerve examination including anesthetic testing which documents any increased or decreased trigeminal nerve sensitivity changes outside the trigeminal nerve; neurologicand rules out other and (6) MRI imaging in some cases atypical toothache first nonobviousFinally, when a presents, direct microscopic examination of the tooth for . The majority incomplete tooth fracture is also suggested of these patients are women over the age 30 with pain in Multiple causes exist the posterior teeth/alveolar arch. direct nerve including painneuropathicfor sustained (e.g., associated with fracture or surgical injury nerve compression , nerve injection injurytreatment), neoplastic (e.g., implant, osseous growth, injury and infection-inflammation damage to the invasion) . Sustained nerve pain is commonly seen in nerve itself patients with psychiatric impairment. It may be that the unrelenting nature of the pain itself alters the patients personality. Treatment includes pharmacologic medications which suppress nerve activity. The common medications used for and phantom tooth odontalgiaatypical , topical tricyclics, gabapentinpain include With earlier opioidsanesthetics, and treatment, better pain control and this should also prevent secondary psychiatric disease from developing and lower the number of inappropriate treatments ?OdontalgiaAtypical What is ) is a condition in which a tooth is AO (OdontalgiaAtypical very painful but nothing can be found wrong with the tooth. The pain is continuous, usually burning, aching and sometimes throbbing and most often occurs in upper .molars) or bicuspids (premolars Since symptoms are very similar to those caused by a “toothache“, often numerous dental procedures are done. pulp To complicate matters, these treatments (such as ) may offer tooth extraction or root-tip surgery, extirpation temporary relief from pain, only to have the pain return. What are the Signs the pain may spread absence of any sign of pathologyin the to areas of the face, neck, and shoulder. include a continuous burning, aching pain in a Symptoms tooth or in the bone / gum surrounding a tooth. over the increased sensitivity to pressureOften there in painful region. Often nothing shows up on diagnostic tests, no abnormalities are found on X-rays and no obvious cause for the “tooth pain” can be found. the pain.localisingdifficulty Patients often have seems to AOAll ages can be affected except for children. be more common in women in their mid 30 - 40s. Diagnosis is based primarily on symptoms and on elimination of other possible disorders. Tests may include diagnostic If a nerve dental X-rays, CT scans and possibly MRI scans. should be considered AOblock does not result in pain reduction then a diagnosis of How is it treated? Medications such as painkillers and sedatives are not effective in AO. Surgery and other dental interventions rarely provide relief. pain which is AO medications can reduce Anti-depressants Anti-depressants effects (analgesicprobably due to their have the ability to produce low-grade pain relief at lower AO effects. anti-depressantstrengths) and not to their patients are generally not depressed. to painful tissue has also been capsaicinTopical application of .AOinvestigated as a treatment for The outcome is usually fair, with many patients obtaining complete relief from pain. Especially in the absence of overt pathology, particular attention should be paid to avoiding any unnecessary and potentially dangerous dental intervention on the teeth. AO is surprisingly common, of uncertain origin and potentially treatable. Dysgeusia is the medical term for an altered, Dysgeusia distorted or reduced ability to taste. Specific types of taste disorders include (a reduced ability to taste) and hypogeusia (an inability to detect taste). A persistent ageusia ) is parageusiabad taste in the mouth ( sometimes used interchangeably with Distortion may include sensing a dysgeusia.So taste that is not present in the mouth, or misidentifying a taste (e.g., pleasant-tasting foods now taste awful). The sense of taste begins in the mouth. A person is born with approximately 10,000 taste buds, most of which are located on of the tongue. Taste papillaeor around the buds are also located on the soft palate, and the first epiglottis , larynx , pharynx part of the esophagus Each taste bud contains anywhere from 50 to 100 taste cells. Each of these cells responds best to one of five basic taste sensations: Sweet (e.g., sugar) Sour (e.g., lemon juice) Salty Bitter (e.g., aspirin) ) or “savory” umame (sometimes spelled Umami When stimulated, a taste cell sends a nerve impulse to the brain, where a certain taste is identified and sensed. New taste cells are constantly being produced by the body, replacing existing taste cells every 10 days throughout a persons life. Thus, if taste cells are destroyed by burning the mouth with a hot liquid, any consequent taste disorder is usually temporary, until new For complex tastes, the sense taste cells are produced . Many taste disorders are actually of smell is required. , )dysosmiaassociated with an impaired sense of smell ( which can occur due to colds or other upper respiratory infections. Often, people do not discover they have a . smell disorder until they notice a problem with taste More than 200,000 people seek help for a taste or smell disorder every year, according to the National Institutes of Health. The actual incidence of these disorders is estimated to be in the millions because a large number of people do not seek help for the condition. Taste disorders can affect a persons quality of life. It can lead to a decreased appetite, poor nutrition and the inability to identify potentially harmful foods or beverages Taste disorders can have many different causes. Various illnesses (e.g., colds, sore throat), lifestyle habits (e.g., smoking), irritants (e.g., insecticides, certain prescription mouthwash) and other factors (e.g., medications) can . dysgeusiacontribute to Patients are urged to contact their physician or dentist if they have a taste disorder that lasts two weeks or longer. A thorough medical history may be taken, including questions about symptoms, current medications and medical conditions, recent illnesses, and whether the patients sense of smell is affected. that measure the extent of a persons sense of Tests. taste or smell may be performed. If no underlying medical or dental condition is identified, the patient may to a facility that specializes in taste and smell referredbe disorders. The physician, dentist or other healthcare provider will attempt to identify the underlying cause of a begin dysgeusiaHow symptoms of . dysgeusiapatients For instance, a . can help indicate the underlying cause sudden loss of taste may be due to trauma or a dysgeusiasevere upper respiratory infection. For that occurs off and on, an allergy or exposure to .chemicals may be the cause . Typically, depends on its causedysgeusiaTreatment of treating the underlying condition will also eliminate the . The prognosis for patients is dysgeusiapatients can be dysgeusiagenerally excellent when the cause of identified and treated. However, long-term recovery is cannot dysgeusiamore complicated when the source of results from an dysgeusiabe identified or when dysgeusiaFor the most part, untreatable condition. . However, quitting smoking, cannot be prevented practicing good oral hygiene, having regular dental examinations and treating sinus problems all can . dysgeusiacontribute to reducing the likelihood of SALIVARY GLAND ANATOMY AND PHYSIOLOGY ,submandibularThere are three major salivary glands: parotid, and sublingual. These are paired glands that secrete a highly modified saliva through a branching duct system. Parotid duct, the orifice of whichStensonssaliva is released through mucosa adjacent to the maxillary firstbuccalis visible on the molars. Sublingual saliva may enter the floor of the mouth via a series of short independent ducts, but will empty into the (Whartons) duct about half of the time. Thesubmandibular orifice of Whartons duct is located sublingually on either side . There are also thousands of minor salivaryfrenumof the lingual glands throughout the mouth, most of which are named , etc). Thesebuccalfor their anatomic location (labial, palatal, minor glands are located just below the mucosal surface and communicate with the oral cavity with short ducts. Saliva is the product of the major and minor salivary glands It is a highly complex mixture of dispersed throughout the oral cavity. The three major water and organic and non-organic components share a basic anatomic structure. they are salivary glands arranged much like cellsductal and acinarcomposed of secretory cells make up the acinarcluster of grapes on stems. The end piece. those of the parotid gland are serous, those of the gland submandibularsublingual gland are mucous, and those of the are of a mixed mucous and serous type. The duct cells (the “stems”) into aciniform a branching system that carries the saliva from the the oral cavity. The duct cell morphology changes as it progresses junction toward the mouthacinarfrom the . proteins are produced and transported into the cells. The ductal and acinarsaliva through both is endpiece acinarprimary saliva within the isotonic with serum but undergoes extensive modification within the duct system, with of sodium and chloride and secretion resorption of potassium. The saliva, as it enters the oral cavity, is a protein-rich hypotonic fluid. The secretion of saliva is controlled by sympathetic and parasympathetic neural input. xerostomia called “dry mouth,“ among patients who take medications, have certain connective tissue or immunological disorders or have been treated with radiation therapy. When xerostomia is the result of a reduction in salivary flow, significant oral complications can occur. develops when the amount of saliva oftenXerostomia that bathes the oral mucous membranes is reduced. However, symptoms may occur without a measurable reduction in salivary gland output. The most frequently xerostomicreported cause of xerostomia is the use of . A number of commonly prescribed drugs medications with a variety of pharmacological activities have been found to produce xerostomia as a side effect. Additionally, xerostomia often is associated with , a condition that involves dry mouth syndromeSjgrens and dry eyes and that may be accompanied by rheumatoid arthritis or a related connective tissue disease. Xerostomia also is a frequent complication of . radiation therapy Xerostomia is an uncomfortable condition and a common oral complaint for which patients may seek relief from dental Complications of xerostomia practitioners. or candidiasisinclude dental caries, . The difficulty with the use of dentures clinician needs to identify the possible ) and provide the patient with cause(s appropriate treatment as a subjective complaint definedXerostomia is of dry mouth that may result from a decrease in estimatedthe production of saliva. Xerostomia is to affect millions of people in the United States. Studies have found the condition in 17 to 29 percent of sampled populations based on self- reports or measurements of salivary flow rates. Complaints of dry mouth generally are more prevalent in women its diminution or absence can cause significant reduction in a patients morbidity and a . The primary perceptions of quality of life constituents of saliva are water, proteins and taste, electrolytes. These components enhance speech and swallowing and facilitate irrigation, lubrication and protection of the mucous membranes in the upper digestive tract Additional physiological functions of saliva antimicrobial and buffering activities that provide . protect the teeth from dental caries .Patients initially may be unaware that a reduction in salivary flow is occurring unless some of its complications, such as an increase in cervical dental caries, becomes apparent. Only after the development of symptomswhich may include soreness, burning or difficulty with swallowingis the patient likely to seek relief from the practitioner physiopathology and sublingual submandibularSaliva is produced by the parotid, glands, as well as by hundreds of minor salivary glands that are Daily salivary output is estimated distributed throughout the mouth. Salivary flow is categorized as , to be approximately one liter per day , as occurs when an , or resting, and stimulatedunstimulated mechanismssecretoryexogenous factor is acting on the parasympathetic and sympathetic nervous systems Both the . Parasympathetic stimulation induces innervate the salivary glands more watery secretions, whereas the sympathetic system produces more viscous flow. Therefore, a sensation of dryness may occur, for , which cause during episodes of acute anxiety or stressexample, changes in salivary composition owing to predominant sympathetic stimulation during such periods. causes Xerostomia is a common and significant side effect of Medications. many commonly prescribed drugs Nevertheless, the risk for xerostomia increases with the number of drugs being taken. Older people, therefore, are more likely to be affected. In the geriatric population, drug-induced xerostomia has been reported to contribute to difficulty with chewing and swallowing; this may result in avoidance of certain foods. A variety of drugs that have a wide range of therapeutic activities have been reported to cause xerostomia in 10 percent or more of also can be an extension of hyposalivationpatients. Drug-induced parasympatholyticthe drugs intended action, as seen with the side effect with anticholinergicagents (such as atropine), or as an antidepressants. tricyclicdrugs such as When xerostomia is associated syndrome.Sjgrens , also known as “dry eyes,“ it may xerophthalmiawith represent a chronic autoimmune condition that is syndrome, which affects Sjgrensrecognized as predominantly women after the fourth decade of life. In syndrome, the disease is limited to the Sjgrensprimary Sjgrenseyes and salivary glands. With secondary syndrome, patients also have an autoimmune or connective tissue disease .It is estimated that 15 percent of patients with rheumatoid arthritis, 25 percent of those with systemic sclerosis and 30 percent of those with Sjgrens may develop erythematosussystemic lupus syndrome. The xerostomia that is associated with primary syndrome has been Sjgrensand secondary lymphocyticprogressive attributed to the secretoryinfiltration that gradually destroys the . of the major and minor salivary glandsacini Another explanation for the loss of glandular inhibition of nerve