OROFACIAL PAIN SPECIALIST: Specific to 5th nerve-Trigeminal nerve that supplies the chewing system.

Types Nerves:

1. Motor nerves
2. Pain reporting system
3. Sympathetic and parasympathetic systems
4. Sensory nerves oral cavity
5. Pain Inhibitory system
6. Nerves to blood vessels

Nerve damage mimics the pathologies of the structures that they innervate causing diagnostic confusion.

Types Nerve Damage:

1. Neuritis
2. Neuralgia
3. Neuroma
4. Burning mouth
5. Numbness

Nerve Damage causes:

1. Surgery
2. Needle
3. Cuts
4. Trauma
5. Viral
6. Tumor
7. High anxiety

Symptoms:

1. Tingle
2. Pin price
3. Numbness.
4. Sharp-shoot-electric.
5. burning
6. Reduce sensations

Trigeminal Neuralgia

When the trigger of Trigeminal Neuralgia (TN) is in oral region, it requires Orofacial Pain Specialist due it’s ability to mimic pathologies of the chewing system.

Cluster of episodes of severe pain in or near oral cavity.

Reduce pain Needs:

1. Severe attacks of pain prompts emergency treatment
2. Caring dentist, endodontist, or oral surgeons are driven to perform invasive procedures on teeth
3. Dental professional are treating the symptom of pain, TOOTH PAIN
4. Orofacial pain specialist treats real cause blood vessel irritation of trigeminal nerve

Concerns:

1. Dentist aware: TN looks like severe toothaches w/o dental disease
2. Neurologist aware: dental pathology can look like Trigeminal Neuralgia
3. Orofacial pain specialist can serve diagnostic clearinghouse for Trigeminal Neuralgia
4. Medical field aware that most patients w/ Trigeminal Neuralgia have TMD

Trigeminal Neuralia resembles:

1. Toothache
2. Jaw pain
3. Facial pain
4. Gum pain

Diagnosis Trigeminal Neuralgia:

1. Intensity
2. Description
3. Pattern
4. No dental path

Trigeminal Neuralgia:

1. Severe pain triggered by light touch-brush-lip movement-wind face-food moving-toothbrush near trigger zone
2. A central brain damage by pulsating artery over the top of the trigeminal nerve that supplies the tooth-gum-bone of maxilla or mandible
3. Increase probability w/ increase in age
4. Severity pain causes demand quick fixes: crown, root canal, extraction
5. Dental treatments have little to no effect on
6. Source pain is in middle cranial fossa but site is tooth-face-jaw
7. Diagnosis is made by orofacial pain specialist

Management of severe pain Trigeminal Nerve Damage:

1. Refer by health professional orofacial pain
2. Exam by orofacial pain for diagnosis
3. Test diagnosis w/ anti convulsant
4. Refer neurosurgeon
5. Refer orofacial pain specialist treat moderate TMD

Treatment for Trigeminal Nerve Damage

1. Anticonvulsants
2. Mircovascular Decompression

Caution: Gamma knife has been proposed as treatment TN. Burning trigeminal nerve should not be first line treatment for TN when decompression procedure is so effective,

Burning Mouth

Burning Mouth Syndrome: BMS

1. Excessive Anxiety creates nerve hyperfunction
2. In state of poor healing nerve does not recover from microdamage of function
3. Loss of inhibitory, dampening, or filtering of pain impulses
4. Creates runaway pain-central sensitization
5. Many times BMS is combination of several causes

BMS Statistics:

1. 5% population
2. Tip togue & ant palate
3. Female (4 to 1)
4. 5^th to 7^th decade
5. Pain in trigeminal nerve
6. Absence trauma-event-infection-causalgia
7. Can have taste changes

Possible Causes:

1. Viral, Fungal
2. Salivary gland dysfunction
3. Acid reflux
4. Dry mouth
5. High anxiety
6. Menopausal
7. Degeneration chorda tympani
8. Geographic tongue
9. Demyelination nerve fibers tongue-palate

BMS is refractory:

1. single
2. acute pain treatment
3. fast quick cheap
4. insurance approved therapies
5. symptom driven therapies

Diagnostic difficulty:

• Multifactorial
• Aggravated by anxiety
• No obvious cause
• No clinical signs

Suggested therapies:

• Oral topical
• Antianxiety & antidepressants meds
• Behavioral interventions
• Nutritional supplements
• Dry mouth therapyd
• IBS therapy
• Hormonal therapy
• Biofeedback-Counseling
• Psychiatric

As with most chronic pains, the diagnosis requires the most detail examination along with blood, nutritional, medication, topical, imaging, ultrasound testing, BMS crosses so many different health fields that inter disciplinary communication is required, necessary, critical, and impossible in today’s insurance & government controlled health system.

Neurovascular

Neurovascular pain is pain from the nerve that innervates muscle of the blood vessels. The pain is severe. When blood vessel is near tooth it can appear as a toothache. When the blood vessel in other locations like temple forehead it can look like HA.

Neurovascular-NVOP

1. Atypical Odontalgia-MWoA-
2. Chronic Paroxymal Hemicrania-CPH
3. Trigeminal Autonomic Cephalgia-TAC
4. Short unilateral neuralgia conjunctival injection-SUNCT
5. Post Traumatic trigeminal neuropathy- PTTN
6. Cluster headaches

Neurovascular Tooth Symptoms

1. Severe Throbbing
2. Attacks: Several per week
3. Obvious or hidden intraoral nerve injury
4. Unilateral (2/3) or bilateral (1/3)
5. Intra-oral migraine pain induced by trauma
6. Mimic tooth pathology
7. Spontaneous or evoked pain
8. Late age onset
9. Provokes invasive single dental tx
10. Compounding nerve injuries due tx
11. Hidden-high anxiety (up-regulation sympathetic system)
12. Duration: Last min to hr