Facial Pain

• Study notes for diseases that cause facial pain

Dental Diseases

• Dental pain is the most common cause of facial pain.

Reversible Pulpitis

• Dental pain can arise from reversible pulpitis.
• Requires restorative dental treatments.

Irreversible Pulpitis

• Dental pain can arise from irreversible pulpitis.
• Requires root canal therapy.

Dentine Hypersensitivity

• Dental pain can come from dentine hypersensitivity.
• Use desensitizing toothpastes, fluoride varnishes, or restorative materials to cover exposed dentine.

Cracked Tooth Syndrome

• Dental pain can arise from cracked tooth syndrome.
• Requires restorative dental treatments.

Dental Abscesses

• Dental pain can arise from dental abscesses.
• Requires root canal therapy.

Apical Periodontitis

• Dental pain can arise from apical periodontitis.
• Painful response to biting or pressure, sensitivity to temperature changes.
• Dental X-rays identify changes in the periapical area.
• Requires root canal therapy or extraction if severely damaged.

Lateral Periodontitis

• Dental pain can arise from lateral periodontitis.
• Requires restorative dental treatments.

Temporomandibular Disorders (TMD)

• Jaw pain, dysfunction, clicking or popping sounds, limited or painful jaw movements are symptoms.
• Conservative treatments include physical therapy, splint therapy, and pain management; surgical interventions in severe cases.

Myofascial Pain Dysfunction Syndrome (MPDS)

• Is a type of Temporomandibular Disorder.
• Localized muscle pain, presence of trigger points which are tender on palpation.
• Taught muscle with Knot.
• Treatment options include massage therapy, NSAIDs, muscle relaxants, and localized treatments like dry needling or Botox injections.

Facial Arthromyalgia

• Chronic/ intermittent TMJ pain.
• Aim for pain relief, physical therapy, lifestyle adjustments.

Degenerative Arthritis

• Joint pain, stiffness, reduced range of motion, and sometimes a grinding sensation during jaw movement are symptoms.
• Imaging studies such as X-rays or MRI to assess joint damage.
• Use Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and occlusal splints to alleviate symptoms.
• Joint replacement surgery might be required for severe cases.

Septic Arthritis

• Fever is an urgent symptom.
• Requires Immediate medical evaluation and specialist referral.

Osteomyelitis

• Fever is an urgent symptom.
• Requires Immediate medical evaluation and specialist referral.

Nasopharyngeal Carcinoma

• Nasal blockage or congestion, nosebleeds, hearing loss, headache, or facial pain are symptoms.
• Imaging studies like MRI or CT scans, biopsy of the nasopharyngeal region is a necessary investigation.
• Requires Combination of chemotherapy, radiotherapy, and possibly surgery.

Oral Cancer

• Unexplained mouth ulcers, persistent lumps, red or white patches in the mouth are symptoms.
• A Biopsy of suspicious areas is required.
• Requires Referral to specialists for possible surgical removal, radiation, or chemotherapy.

Tumor pathology

• TMJ swelling and facial asymmetry are indications.
• Headache, tenderness, and visual issues may be present.
• Imaging studies (MRI, CT), biopsy for tumor suspicion are necessary investigations.
• Management depends on cause, options include surgery, medications (antibiotics for infection, steroids for arteritis).

Intracranial Pathology

• Pain on exertion or sleep interruption are red flags.
• Requires immediate medical evaluation, specialist referral.

Giant Cell Arteritis

• Headache, scalp tenderness, jaw claudication, and vision problems are symptoms.
• Elevated inflammatory markers, temporal artery biopsy are necessary investigations.
• Requires urgent treatment with high-dose Corticosteroids (Prednisolone) to prevent complications like blindness.

Cluster Headaches

• Intense unilateral pain, often around the eye, with associated symptoms like rhinorrhea and lacrimation are symptoms.
• Vascular changes at the Base of the Skull.
• Requires Acute relief with high-flow oxygen or sumatriptan.
• Preventive treatments include verapamil or corticosteroids.

Migraines

• Severe, throbbing headaches often accompanied by nausea, photophobia, and phonophobia are symptoms.
• Requires Lifestyle Modifications, acute treatment with NSAIDs or triptans.
• Preventive Medications like beta-blockers or antiepileptics may be needed.

Trigeminal Neuralgia

• Sudden, unilateral, severe, brief, stabbing, recurrent pain in CN V distribution are characteristics.
• Eating, talking, washing face are triggers.
• Can be idiopathic or secondary (tumor, artery pressure).
• Medical treatment requires Sodium channel blockers.

Glossopharyngeal Neuralgia

• Sharp pain in the base of the tongue, throat, and ear, triggered by swallowing or speaking are symptoms.
• Similar to trigeminal neuralgia, often treated with carbamazepine or microvascular decompression.

Post-Herpetic Neuralgia

• Persistent pain following shingles, typically along a dermatome are symptoms.
• Requires Antivirals like acyclovir during the viral outbreak, followed by pain management with drugs like gabapentin.

Persistent Idiopathic Facial Pain (PIFP)

• Constant, unexplained facial pain without sensory loss are symptoms.
• Antidepressants and cognitive behavioral therapy are management options.

Atypical Odontalgia

• Persistent idiopathic facial pain often misdiagnosed as toothache.
• Difficult to treat; may respond to antidepressants and anticonvulsants.

Burning Mouth Syndrome

• Persistent burning sensation in the mouth without an obvious medical or dental cause.
• Requires Screening for nutritional deficiencies, diabetes, and allergies.
• Treating underlying conditions, cognitive behavioral therapy, and medications like clonazepam or gabapentin are management options.

Candidiasis

• Burning sensation in the mouth, possible white patches or redness are symptoms.
• Requires Clinical examination and swab tests.
• Antifungal medications and maintaining good oral hygiene are management options.

Neurovascular Pain

• Symptoms are similar to migraines, but includes cluster headaches with sharp, piercing pain around the temples or eyes.
• Requires Oxygen therapy, triptans, and preventive medications such as verapamil.

Dislocation of the TMJ

• TMJ exceeds normal range, often treated with muscle relaxers and possible after alcohol consumption.

Osteoarthritis of the TMJ

• 'Degenerative arthritis', pain due to bone-on-bone contact, limited opening, crepitus.
• Radiological Signs include flattening on condyle, erosions, osteophytes.
• Symptomatic relief with splints, NSAIDs, arthrocentesis.

Fibromyalgia

• Widespread musculoskeletal pain, fatigue, and cognitive difficulties are symptoms.
• Requires Multidisciplinary approach including medications (antidepressants, antiepileptics), physical therapy, and CBT.

Fibrous Dysplasia

• Bone pain and deformity, usually in the maxilla are symptoms.
• Radiographic findings of ground glass appearance during investigations.
• Requires Observation or surgical intervention in cases of functional impairment or pain.

Paget’s Disease

• Bone pain, enlargement, and deformities are symptoms.
• Disrupts bone renewal cycle.
• Elevated alkaline phosphatase, characteristic radiographic changes during investigations.
• Requires Bisphosphonates to control bone turnover.

Sinusitis

• Facial pain, nasal congestion, discharge, fever are symptoms and caused by Inflammation of Maxillary Sinus.
• Requires Decongestants, analgesics, and antibiotics for bacterial infections.

Pericoronitis

• Painful swelling in the gum overlying a partially erupted tooth, usually the wisdom tooth are symptoms.
• Requires Good oral hygiene, irrigation, and if recurrent, extraction of the offending tooth.

Caries

• Tooth pain and sensitivity, especially to hot, cold, or sweet stimuli are symptoms.
• Filling cavities, root canal treatment for more severe cases, and crowns for restoration are required.

Hypersensitivity reaction

• Oral discomfort, possible mucosal lesions or contact dermatitis are symptoms.
• Patch testing for allergies are investigation
• Requires Identification and replacement of the offending material.