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ePaper created 2015-04-13, 15:09:21 | version 1.33.01
as atypical facial pain. This is pain in the re- gion of the teeth and/or tooth-bearing area in which a dental cause cannot be identi- fied. In some cases, the pain is related to nerve injury. This can occur after extrac- tion of teeth, especially third molars, as well as after root canal work, implants or fa- cial trauma. Thispainisoftennotidentifiedandleads to extensive irreversible, unnecessary den- tal treatment. It is probably a neuropathic pain and so needs to be managed in the same manner as other reported neuro- pathicpainsaccordingtoguidelines.Drugs such as anti-depressants and anti-convul- sants are helpful; opioids are of no help in these conditions. However, management with medications alone is insufficient. Pa- tients need to be given an explanation about pain and how it is influenced by past experiences, mood, attention, significant life events, as well as genetic variability. Evidence shows that chronic pain out- comes are improved when a biopsychoso- cial approach is used. Cognitive behaviour therapy needs to be delivered by multidis- ciplinary teams that include clinical psy- chologists and physical therapists. Painthatremains intra-oral anddoes not radiate externally is burning mouth syn- drome. This is defined as a burning pain or discomfort often present continuously on the tongue and other parts of the oral mu- cosa. There are no local or systematic fac- tors to account for this pain, and often it is associated with altered taste and changes in salivary flow. Its highest incidence is in perimenopausal women, and so it had for many years been labelled as a psychologi- cal pain; however, recent research has now shown that this is also a neuropathic pain with abnormalities especially in percep- tion of warmth and cold. There have been a number of ran- domised controlled trials performed, but the evidence of any efficacy is low. Cogni- tive behaviour therapy is effective, espe- cially if it includes a careful explanation of the potential causes of this condition and a reassurance that it is not cancerous. Another rare pain that dentists often see is trigeminal neuralgia. It is defined as a “sudden, usually unilateral, severe, brief, stabbing,recurrentpaininthedistribution of one or more branches of the fifth cranial nerve”thatisprovokedbylighttouchactiv- ities. It has a highly significant impact on quality of life and if poorly managed leads to depression. In some rare cases, it is caused by multiple sclerosis or tumours, but its cause is unknown in the majority of patients. Many patients will have compres- sion of the nerve inside the skull. The pain often presents in the mouth, leading pa- tientstobelievethatthecauseisdentaland to ask dentists to investigate. Again, many patients will undergo un- necessary irreversible treatment until pa- tient or dentist realises that it is non-den- tal. In the early stages, the pain is highly re- sponsive to anti-convulsants, either carba- mazepine or oxcarbazepine, and all guide- linessuggestthisasthefirst-linedrugtype. However, for trigeminal neuralgia, there is a wide range of treatments, both medical and surgical, and so patients need to be seen not only by neurologists or oral physi- cians, but also by neurosurgeons. In cor- rectly diagnosed patients, surgical out- comes can give the longest pain relief peri- ods. It is increasingly important that dentists recognise that there are many non-dental causes of orofacial pain. Time needs to be spent in eliciting a careful history, and irre- versible dental treatment must be avoided. Chronic orofacial pain patients will have better outcomes if managed by specialist teams with multidisciplinary staff. 29Dental Tribune United Kingdom Edition | 1/2015 Prof.Joanna Zakrzewska leads the largest UK multidiscipli- nary facial pain unit at Univer- sity College London Hospitals NHS FoundationTrust. She can be contacted at j.zakrzewska@ucl.ac.uk. TRENDS & APPLICATIONS Orofacial pain can have many non-dental causes. © Poprotskiy Alexey / shutterstock.com Y education everywhere and anytime Y live and interactive webinars Y more than 500 archived courses Y a focused discussion forum Y free membership Y no travel costs Y no time away from the practice Y interaction with colleagues and experts across the globe Y a growing database of scientific articles and case reports Y ADA CERP-recognized credit administration ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. www.DTStudyClub.com Register for FREE! AD DTUK0115_28-29_Orofacial 09.04.15 16:42 Seite 29 DTUK0115_28-29_Orofacial 09.04.1516:42 Seite 29