Differential Diagnosis of Orofacial Pain By Dr bahram

Differential Diagnosis of Orofacial Pain By Dr. bahram Azizi 1

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 2

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 3

Vascular Origin Orofacial Pain • Migraine Headache • Cluster Headache • Peroxymal hemicrania • Vascular Headache 4

History Examination of Orofacial Pain 5

History Ex. of Orofacial Pain 1. Chief complaints A. Location of pain B. Onset of pain – Association with other factors – Progression C. Characteristics of pain – Quality of pain – Behaviour of pain – Temporal – Frequency – Duration – Intensity – Concomitant symptoms – Flow of pain 6

History Ex. of Orofacial Pain 1. Chief complaints (cont. ) D. Aggravating and alleviating factors – Physical modalities – Function and parafunction – Sleep disturbances – Medications – Emotional stress E. Past consultation and/or treatment F. Relationship to other complaints 2. Past medical history 3. Review of systems 4. Psychological assessment 7

Clinical Examination of Orofacial Pain 8

Clinical Examination 1. General examination A. Vital signs – Blood pressure – Pulse rate – Respiratory rate – Temperature B. Cranial nerve evaluation C. Eye evaluation D. Ear evaluation E. Cervical evaluation F. Balance and co-ordination 2. Muscle examination A. Pulpation – Pain and tenderness – Trigger points and pain referal 9

Clinical Examination 3. Masticatory evaluation A. Range of mandibular movement – Measurement – Pain B. Temoromandibular joint evaluation – Pain – Dysfunction C. Oral structures – Mucogingival tissues – Teeth – Periodontium – Occlusion 4. Other diagnostic tests A. Imaging B. Laboratory tests C. Psychologic provocation tests 10

Pain from Intraoral Origin 11

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 12

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 13

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 14

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 15

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 16

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 17

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis • Pain from oral mucosa 18

Non Vascular Origin Orofacial Pain 19

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 20

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 21

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 22

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trieminal Neuralgia • Atypicgal Neuralgia 23

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 24

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 25

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 26

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 27

Vascular Origin Orofacial Pain 28

Vascular Origin Orofacial Pain • Migraine Headache • Cluster Headache • Peroxymal hemicrania • Vascular Headache 29

Vascular Origin Orofacial Pain • Migraine Headache • Cluster Headache • Peroxymal hemicrania • Vascular Headache 30

Vascular Origin Orofacial Pain • Migraine Headache • Cluster Headache • Peroxymal hemicrania • Vascular Headache 31

Vascular Origin Orofacial Pain • Migraine Headache • Cluster Headache • Peroxymal hemicrania • Vascular Headache 32

Vascular Origin Orofacial Pain • Migraine Headache • Cluster Headache • Peroxymal hemicrania • Vascular Headache 33

Pain for Intraoral Origin • Pain from Dentine • Pain from Pulp • Pain from Gingiva • Pain from Periodontatitis • Pain from Periapical periodontitis 34

Non Vascular Origin Orofacial Pain • Pain from Teeth (pulp( • Pain from TM muscle • Pain from TMJ • Sinusitis • Salivary gland • Trigeminal Neuralgia • Atypical Neuralgia 35

Vascular Origin Orofacial Pain • Migraine Headache • Cluster Headache • Peroxymal hemicrania • Vascular Headache 36

Thank You 37