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Pain
and anal
| Question | Answer |
|---|---|
| what two types of dental pain dont have a trigger and might appear spontaneously? | erupting tooth and periodontal pain |
| what might be a cause of the sudden onset of dental pain? | erupting, fractured tooth, necrotic tooth, loss of restoration leading to a sensitive tooth |
| what type of pain has no previous history? | pain due to occlusal trauma and reversible caries |
| what are the causes of generalized dental pain? | periodontal D, occlusal trauma due to grinding, sensitive teeth if due to recessionwh |
| what are the causes of mild to moderate dental pain? | erupting teeth, perio D, reversible decay |
| what are the causes of moderate to severe pain? | irreversible caries, necrotic tooth, sensitive (mild to severe), fractured and occlusal trauma |
| what can be a cause of dull throbbing pain? | erupting tooth, perio D, occlusal trauma (constant pain) |
| what is the cause of sharp pain that appears when pressure is released? | fractured tooth |
| shock like pain? | reversible caries |
| what kind of pain is due to sensitive teeth? | sharp |
| widened PDL means... | occlusal trauma |
| periapical radiolucency means.. | necrotic tooth |
| cold triggers what 4 types of pain? | reversible and irreversible decay, occlusal trauma and sensitive teeth |
| what is a necrotic tooth sensitive to? | percussion and palpation (not hot/cold) |
| tooth sensitive to hot stimulus --> | deep irreversible decay |
| tooth sensitive to sweets --> | reversible decay or sensitive tooth |
| what is the assumption under Biomedical model? | the pain itself is entirely biological in origin + the only Tx for pain is medical approach |
| who is the father of Biopsychosocial Model? | Samuel Dworkin |
| what are the 5 steps of biophychosocial model? | nociception - perception - appraisal - behavior - sick role |
| Temporal summation and cortical plasticity are associated with ______and _____ . | chronic stimulation and altered perception |
| what is the initial stage of forming a subjective pain response | 2nd step - perception |
| what is Appraisal ? | attachment of cognitive and emotional meaning to the painful perceptions perceived |
| what are the two axis for pain assessment? | disease (for bio-related diagnose) and illness(for non-bio-related) |
| pain can be studied as...? | experience and behavior |
| pain experience approach studies : | sensation and pain threshold + pain tolerance |
| pain behavior studies: | respondent (reflexive, acute, same in all pt, automatic) and operant(varies greatly, controlled by consequences) |
| A placebo is about ____ as effective as the assumed strength of the active drug | half |
| factors effecting placebo phenomenon are: | conditioning, contextual cues, verbal instructions, response expectancy |
| 3 types of TMJD | structural, muscular (most common) and inflamm |
| what are 4 main catsegories of McGill Questionnaire? | sensory-discriminative, affective-motivational, evaluative-cognitive and misc |
| TMJ is usually described in McGill Questionnaire as? | #9 and 16: dull, sore, heavy, hurting, aching; annoying, troublesome, miserable, intense, unbearable |
| tooth aches is usually describes in McGill Questionnaire as? | #1,2,3: pulsing, beating, pounding, jumping, flashing, shooting, boring, drilling, stabbing, lancinating , quivering |
| TMJ pain is rated from ___ to ___ on the VAS point scale? | from 2 to 6 |
| examples of cognitive aspect of pain? | voodoo, God`s punishment |
| Beecher concluded that _______ | there was no direct relationship between the severity of the wound and the intensity of pain (war studies) |
| you should be concerned about NSAIDs if pt has: | GI problems, hyperTN and heart failure (they inhibit platelet aggregation), pregnant or aspirin-induced asthma |
| what is the most used NSAID drug? | Ibuprofen |
| oral efficacy of opioids is great/poor? | poor + they cause nausea, vomiting |
| what is the best drug to prevent pain in surgical procedure | give long-acting local A + NSAID |
| where are sensory nerve terminals located around TMJ? | in the retrodiscal area + in the capsular ligament supporting the TMJ |
| Excessive TMJ loading results in inflammation and release of: | IL-1b, TNFa, OH and NO, matrix metal proteases: MMP-2,3,and 9, PGs, leukotrienes and brady |
| what are fxn of mucosa? | sensory (temp, tactile, pain, taste) + immunoprotection (surveillance and response) |
| compare mucosa and skin | mucosa has more nociR; its mechano threshold is lower, heat threshold is similar to skin |
| what enzymes are present in inflamed mucosa? | myloperoxidase - enzyme secreted by neutrophils and tryptase by macrophages |
| what two drugs cause gingival hyperplasia? | dilantin and verapamil |
| where does Herpes lesiosn typically occur? | on the kerat. mucosa; might spread to non-kera |
| where does RAS/RAU occur? | on the non-kera mucosa |
| does Burning Mouth Syndrome display any clinical or lab findings? | no |
| what are examples of idipopathic mucosal conditions? | lichen planus, BMS, migratory glossitis, fissured tongue |
| what are common vesiculoerosive disease? | lichen planus, MMP (pemphioid), erythema multiforme (idiopathic) |
| what are the there common forms of lichen planus? | reticular, atrophic, erosive |
| VED are usually chronic and uncurable. True/False | yes, most of time vesiculoerosive D are chronic |
| which of the VE diseases has a slight oral cancer association? | lichen planus |
| What is the best drug choice to eliminate the symptoms and pain for VED? | corticosteroids |
| What are difference btw RAS and HSV? | RAS - immunological D, on non-kera mucosal; HSV - infectious, on kera mucosa |
| what cells are the predominant producers of cytokines? | Th cells and macs |
| which cytokines inhibits cytokines production and suppresses immunity? | IL-4,10,11,13. IL-10 is most potent (stops TNFa, IL-1,6) |
| which cytokines are responsible for acute inflammation? | IL-1 and IL-6 |
| what does IL-3 do? | hematopoetic stimulation |
| what does IL-5 do? | eosinophils stimulation |
| which IL stimulate IFN release? | IL-12 and 18 |
| What`s the activity of TNFa? | cell death, inflammation, PAIN |
| which inflammatory cytokine induces thermal allodynia and thermal hyperalgesia? | IL-6 (assos with neuropathic pain), TNFa also produces mechanic and thermal hyperalgesia |
| which cytokine induces Wallerian degeneration when injected into nerve? | TNFa (sicne it induces cell death) |
| low blood level of which cytokines might be assos with chronic pain? | IL-4 and 10 |
| what does minocycline do? | inhibits microglia --> reduces neuropathic pain |
| Anesthesia without traumatic damage point to... | stroke or occult tumor |
| what is odontalgia? | severe throbbing pain in a tooth w/out any obvious pathology |
| Drugs used to treat neuropathic pain are: | opioids (Tramadol), anti-convulsants, TCA and nontricyclic AD and topical lidocaine |
| what is the drug of choice for Tx of Trigeminal Neuralgia? | Carbamazepine |
| where would u find silent nociceptors | viscera, muscles, skin and teeth |
| what are examples of somatic tissue sensitization in visceral pain? | muscle tenderness + somatic hyperalgesia |
| what is spinal cord distribution of visceral afferent (Adelta and C)? | laminas 1,2,5,10 |
| Where are the cell bodies of visceral afferent located? | DRG |
| The phenomenon of referred visceral pain is the basis for __________ | secondary allodynia or hyperalgesia. |
| muscle afferent carry info to what laminas in SC? | 1,2,3,4,5 (slide 21) from there into thalamus via CONTRAlateral ascending tract or 1, 6-9 (slide 24) |
| nociceptive innervation of the teeth can be ___ and ___ | external (PDL, gums) and internal (pulp and bone marrow) |
| what types of nerve fibers will u find in pulp? | A delta (majority) of slow and fast type, C fibers and A beta |
| what is unique about referred dental pain? | in never refers to OPPOSITE side |
Created by:
fufik