From: Multi-dimensionality of chronic pain of the oral cavity and face
 | Post traumatic trigeminal neuropathy | Buring mouth syndrome | Temporomandibular disorders | Trigeminal neuralgia | Persistent idiopathic facial pain | Trigeminal post herpetic neuralgia |
---|---|---|---|---|---|---|
Epidemiology | becoming increasingly common | rare | common | rare | rare | rare |
Onset | 3-6Â months of traumatic event | slow | sometimes starts abruptly | memorable, sudden | slow | slow post herpes zoster |
Duration | continuous with minor fluctuations, some have intermittent episodes | continuous | often constant | intermittent seconds to minutes | constant | constant |
Periodicity | constant | can vary throughout the day | fluctuations often worse am/evening | refractory periods, many attacks a day periods of complete remission weeks, months | varies, can have periods of no pain | may be excacerbations |
Site | distribution of a nerve branch, tooth or tooth bearing area | tongue, lips, palate | masseter, temporalis, around TMJ,ear, retromolar area | V2, V3 most common intraoral and extra oral | non anatomical, gradually gets larger | anatomic distribution, most common ophthalmic branch |
Radiation | nil | all parts of the oral mucosa | may radiate to neck | only within trigeminal distribution | can spread over whole face, head, intra oral | little |
Character | dull, burning, tingling, pins and needles at times sharp | burning, stinging, sore | aching,heavy, deep, can be sharp | sharp, shooting, lightening, may be a dull ache, burning after pain | dull, nagging, can be sharp | burning,, pins and needles |
Severity | moderate to severe | mild to severe | variable moderate to severe | moderate to severe | moderate to severe | moderat to severe |
Aggravating factors | touch | sometimes certain food, | prolonged chewing, opening wide, jaw movements | light touch, eating, some attacks are spontaneous | fatigue, stress | light touch, |
Associated factors | may be altered sensation, reduced quality of life, history of trauma or dental procedure | altered taste, dry mouth, depression, anxiety, poor quality of life | clenching, bruxism, may have clicking of TMJ, locking, reduced opening, headaches, migraines | very rare autonomic features, fear of pain return, depression, poor quality of life | often other chronic pain, significant life events, vulnerable personalities, | may be altered sensation, skin changes |
Examination | allodynia, hypoesthesia | nil, sometimes geographic tongue | palpation of muscles/joint induces same pain, unassisted reduced opening, clicking, intraorally evidence of frictional keratosis in cheeks, attrition of teeth | may trigger attack on touch, very rarely sensory changes | nil | allodynia, hypoaesthesia, hyperaesthesia |
Management | drugs for neuropathic pain many benefit from CBT | neuropathic drugs, clonazepam, CBT | education, physiotherapy, psychology, anti- inflammatory drugs | carbamazepine/oxcarbazepine, neurosurgical procedures | CBT, antidepressant drugs | nortryptyline, pregablin, gapabentin, lidocaine patches |