29 Questions
What is the definition of pain according to the International Association for the Study of Pain (2020)?
An unpleasant sensory and emotional experience associated with tissue damage
According to the text, how is the source of pain found?
Mainly by what we hear
Historically, what type of pain scales have been used in clinical settings?
0, 1 , 2, 3, 4, 5, 6, 7, 8, 9,10
What does a score of '10' on the pain scale represent?
As much pain as imaginable.
Which term describes a patient who often asks for specific drugs, has very good pharmacology knowledge, and may have a burnt down tooth?
Drug seeker
What is the chief complaint often reported by a 'Munchausen syndrome' patient or 'Munchausen by-proxy' patient?
Pain everywhere or in specific site
What is important to document prior to any invasive procedure for non-pulpal diseases?
All medical history of the patient
What did Yogi Berra suggest in the quote 'We made too many wrong mistakes'?
Errors in diagnosis
What condition can manifest as orofacial pain instead of chest pain during myocardial infarction?
Trigeminal neuralgia
What is a possible cause of jaw pain that does not necessarily indicate vital pulp involvement?
Salivary gland infection
Which condition can cause diffuse pain in the maxillary teeth, worsened by sudden movements?
Maxillary sinusitis
What condition is characterized by pain that comes in bursts and usually affects females more than males post menopause?
Trigeminal neuralgia
What can cause acute pain in a specific neural segment due to risk factors such as emotional stress or immunocompromising diseases?
Herpes zoster
What may cause pain similar to cluster headache or odontalgia in the maxillary premolar area?
Cocaine snorting
What condition can be caused by deafferentation pain secondary to trauma or central sensitization?
'Persistent idiopathic facial pain'
What can cause non-vital pulp and periapical lesions without obvious causes?
'Malignant lesions in the jaws'
What condition is often associated with eating and causes moderate to severe pain in the jaw?
'Salivary gland issues'
What might be a sign of a missed diagnosis and increased risk of death during myocardial infarction?
Orofacial pain instead of chest pain
What can be triggered by dental pain or discomfort?
Cluster headaches
What may cause acute pain associated with specific risk factors like emotional stress or immunocompromising diseases?
Herpes zoster
In a study of patients referred for endodontic treatment, what percentage had solely endodontic problems?
88%
What did Gracely et al. (1979) identify in relation to pain intensity?
Various descriptors for pain intensity in a rating scale
What can cause referred pain from teeth?
Angina pectoris
What is necessary prior to any invasive procedure to determine the source of pain?
All of the above
What cardiac condition can cause pain in the lower jaw?
Angina pectoris
What is the average diagnostic delay for persistent idiopathic facial pain and dentoalveolar pain?
19.3 months
What is commonly missed during endodontic treatment in lower first premolars?
Second canal
What can patients with necrotic pulp experience?
'Dull' pain
What percentage of patients with angina pectoris experience only jaw/teeth symptoms?
18
Study Notes
- Historically, simple pain scales have been used in clinical settings for measuring pain, but they may not capture both sensory and emotional aspects.
- One such scale is the Visual Analogue Scale (VAS), where pain is rated by marking on a line with a predetermined length.
- The human pulp, which contains sensory neurofibers, can be affected by disease leading to pain. A study showed poor correlation between perceived pain and nerve activity in inflamed human pulp.
- Gracely et al. (1979) identified various descriptors for pain intensity in a rating scale.
- In a study of patients referred for endodontic treatment, 88% had solely endodontic problems, while 9% had other oral pain issues in addition.
- A prospective study of complex non-dental orofacial pain cases found that 44 of 100 patients had undergone previous dental procedures.
- The diagnostic delay for persistent idiopathic facial pain and dentoalveolar pain was on average 19.3 months, with longer delays for intraoral pain.
- Referred pain from teeth can manifest as pain in areas other than the affected tooth, with lower teeth more likely to refer to upper teeth and vise versa.
- Prior to any invasive procedure, a thorough examination is necessary to determine the source of pain, including examination of the chief complaint, changes in the pain, current status, and vitality testing.
- Commonly missed canals during endodontic treatment include the second M-F canal in upper molars, second canal in lower anteriors, second canal in lower first premolars, and second canal in the distal root of lower molars.
- Patients with necrotic pulp may experience dull pain and difficulty locating the source due to neuroplastic changes in the CNS.
- Angina pectoris, a cardiac condition, can cause pain in the lower jaw, with up to 18% of patients experiencing only jaw/teeth symptoms and 32% reporting both craniofacial and other regional pain.
- The most common craniofacial pain locations during angina pectoris are the throat, left mandible, right mandible, left temporomandibular joint/ear region, and teeth.
- Female subjects were more likely to experience craniofacial pain as the dominating symptom in the absence of chest pain.
Test your knowledge of the association between angina pectoris and craniofacial pain as discussed in the JADA 2007 article. Explore the significance of craniofacial pain in patients with verified cardiac ischemic episodes and its potential implications for early diagnosis and treatment.
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