Introduction
Diseases of the teeth and periodontal structures
Diseases of the oral mucosa
Nondental causes of oral pain
- Myofacial pain (m/c)
- Referred from muscles of mastication
- Many sufferers exhibit bruxism secondary to stress and anxiety
- Temporomandibular joint disorder
- Risk factors: joint trauma (eg, injury, bruxism), psychiatric illness (eg, anxiety, history of abuse)
- Clinical manifestations
- Facial pain (worsens with jaw motion)
- Ear pain, tinnitus
- Headache (unilateral, worse on awakening)
- Jaw dysfunction
- Diagnosis
- Tenderness of mastication muscles
- Crepitus or clicking with TMJ motion
- Management
- Education (eg, avoidance of triggers, soft diet)
- Dental splints (if bruxism suspected)
- NSAIDs (eg, naproxen), muscle relaxants (eg, cyclobenzaprine)
- Migrainous neuralgia
- May be localized to the mouth.
Diseases of the salivary glands
Dental care for medically complex patients
- Osteonecrosis of the jaw (ONJ)
- Chronic swelling, mild pain, and exposed, necrotic bone.
- Often triggered by tooth extractions or other invasive dental procedures.
- The course can be intractable, and treatment is largely supportive with caraeful oral hygiene and antibacterial rinses.
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