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Table 1 The main characteristics of the most common chronic non dental pains and their managment

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

3-6 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

  1. CBT cognitive behaviour therapy.