Odonto And Non Odonto.docx

ALSUNAIDI ABDULRAHMAN

signs and symptoms of non - odontogenic :

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Trigeminal neuralgia : is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain

Symptoms Trigeminal neuralgia symptoms may include one or more of these patterns: 

Episodes of severe, shooting or jabbing pain that may feel like an electric shock

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Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth

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Bouts of pain lasting from a few seconds to several minutes

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Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain

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Constant aching, burning feeling that may occur before it evolves into the spasmlike pain of trigeminal neuralgia

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Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead

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Pain affecting one side of the face at a time, though may rarely affect both sides of the face

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Pain focused in one spot or spread in a wider pattern

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Attacks that become more frequent and intense over time .

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myocardial pain : occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The plaque eventually

breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscle.

Symptoms Common heart attack signs and symptoms include: 

Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back

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Nausea, indigestion, heartburn or abdominal pain

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Shortness of breath

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Cold sweat

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Fatigue

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Lightheadedness or sudden dizziness

3- Maxillary sinusitis : Sinusitis is an inflammation or swelling of the tissue

lining the sinuses. Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow and cause an infection.

Acute Sinusitis Symptoms The main signs include:     

Facial pain or pressure "Stuffed-up" nose Runny nose Loss of smell Cough or congestion

You may also have:    

Fever Bad breath Fatigue Dental pain

It may be acute sinusitis if you have two or more symptoms, or thick, green, or yellow nasal discharge.

Chronic Sinusitis Symptoms You may have these symptoms for 12 weeks or more:     

A feeling of congestion or fullness in your face A nasal obstruction or nasal blockage Pus in the nasal cavity Fever Runny nose or discolored postnasal drainage

4- atypical facial pain : Atypical facial pain (AFP) was an umbrella term used to categorize all facial pains that didn’t mimic the classic symptoms of ( trigeminal neuralgia) — severe pain that could last seconds or minutes and be brought on by triggers. In recent years, however, AFP has come to describe facial pain with no known cause.

Symptoms : -

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Facial pain — The pain may be sporadic, but in many cases it is constant. Some sort of trigger, such as moving, eating, wind or being touched, frequently brings it on. The pain produces burning, stabbing, shooting or electric-shock sensations and may result in itching or tingling.

phantom tooth pain : also known as Atypical odontalgia and atypical facial pain is characterized by chronic pain in a tooth or teeth, or in a site where teeth have been extracted or following endodontic treatment, without an identifiable cause. Over time, the pain may spread to involve wider areas of the face or jaws.

The pain is called “atypical” because it is a different type of pain than that of a typical toothache. Typical toothache comes and goes and is aggravated by exposure of the tooth to hot or cold food or drink, and/or by chewing or biting on the affected tooth. There is an identifiable cause, such as decay, periodontal disease, or injury to the tooth and the pain is predictably relieved by treatment of the affected tooth.

symptoms include :        

sensations often described as burning, pulsing, crushing, throbbing, itching, pins-and-needles tingling, aching pulling.

The condition can manifest in any part of the face, but the most common area is around the jaw and sides of the face

6- Herpes zoster : is a painful rash that develops on one side of the face or body. The rash consists of blisters that typically scab over in 7 to 10 days. The rash usually clears up within 2 to 4 weeks. Before the rash develops, people often have pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears.

Symptoms :

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Fever Headache Chills Upset stomach

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Neoplastic disease : A neoplasm is an abnormal growth of cells, also known as a

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tumor. Neoplastic diseases are conditions that cause tumor growth — both benign and malignant. Benign tumors are noncancerous growths. They usually grow slowly and can’t spread to other tissues. Malignant tumors are cancerous and can grow slowly or quickly. Malignant tumors carry the risk of metastasis, or spreading to multiple tissues and organs.

Symptoms of neoplastic disease greatly depend on where the neoplasm is located. Regardless symptoms may be : -

anemia

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abdominal pain loss of appetite

-persistent fatigue -chills

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diarrhea

-fever

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bloody stools

-lesions

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skin masses

- shortness of breath

8- Munchausen Syndrome : is a factitious disorder, a mental disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick. Munchausen syndrome is considered a mental illness because it is associated with severe emotional difficulties. Signs and symptoms of Munchausen's syndrome may include pretending to be ill or self-harming to aggravate or induce illness.

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There are four main ways people with Munchausen's syndrome fake or induce illnesses, including: lying about symptoms – for example, choosing symptoms that are difficult to disprove, such as having a severe headache or pretending to have a seizure (fit) or to pass out

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tampering with test results – for example, heating a thermometer to suggest a fever or adding blood to a urine sample

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self-infliction – for example, cutting or burning themselves, poisoning themselves with drugs, or eating food contaminated with bacteria

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aggravating pre-existing conditions – for example, rubbing faeces into wounds to cause an infection, or reopening previously healed wounds

Other signs 

Some clues that a person may have Munchausen's syndrome include: making frequent visits to hospitals in different areas

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claiming to have a history of complex and serious medical conditions with no or little supporting documentary evidence – people often claim they've spent a long time out of the country

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having symptoms that don't correspond to test results

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having symptoms that get worse for no apparent reason

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having very good medical knowledge

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receiving few or no hospital visitors – many people with Munchausen's syndrome adopt a solitary lifestyle and have little contact with friends or family

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being willing to undergo often painful or dangerous tests and procedures

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reporting symptoms that are vague and inconsistent, or reporting a pattern of symptoms that are "textbook examples" of certain conditions

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telling highly unbelievable and often very elaborate stories about their past – such as claiming to be a decorated war hero or that their parents are fantastically rich and powerful

differentiations between odontogenic and non-odontogenic Pain:

-Odontogenic pain is generally derived from either one of two structures associated with the tooth: pulpal or periodontal tissue. -Pulpitis is the most common cause of odontogenic pain - As a visceral organ, pain of the dental pulp is characterized by deep, dull, aching pain that may be difficult to localize - It may present as intermittent or continuous, moderate or severe, sharp or dull, localized or diffuse and may be affected by the time of day or position of the body .- Periodontal pain is more readily localized and identifiable because of proprioceptors located within the periodontal ligament. - Therefore, periodontal pain will follow the characteristics of pain of musculoskeletal origin. - The periodontal receptors are able to accurately localize the pain whether they are lateral or apical to the tooth .

CLINICAL CHARACTERISTICS OF NON-ODONTOGENIC PAIN The clinical presentation of non-odontogenic pain is varied and may mimic other pain disorders which may not originate in the orofacial region. The extent of pain may vary from very mild and intermittent pain to severe, sharp, and continuous. Furthermore, pains that are felt in the tooth do not always originate from dental structures, so it is important to distinguish between site and source of pain to provide correct diagnosis and appropriate treatments. The site of pain is where the pain is felt by the patient, whereas the source of pain is the structure from which the pain actually originates. In ‘primary’ pain, the site and source of pain are coincidental and in the same location. That is, pain occurs where damage to the structure has occurred. Therapy for primary pain is obvious and does not pose a diagnostic dilemma for the clinician. Pain with different sites and sources of pain, known as heterotopic pains, can be diagnostically challenging. Once diagnosed, treatment should be posed at the source of pain, rather than the site. Neurologic mechanisms of heterotopic pain is not well understood but it is thought to be related to central effects of constant nociceptive input from deep structures such as muscles, joints and ligament [8]. Although the terms heterotopic pain and referred pain are often used interchangeably, there are specific distinctions between these terms. Heterotopic pain can be divided more specifically into 3 general types: a) central pain, b) projected pain, and c) referred pain a)Central pain is simply pain derived from the central nervous system (CNS) resulting in pain perceived peripherally. An example of central pain is an intracranial tumor as this will not usually cause pain in the CNS because of the brain’s insensitivity to pain but rather it is felt peripherally. B) Projected pain is pain felt in the peripheral distribution of the same nerve that mediated the primary nociceptive input. An example of projected pain is pain felt in the dermatomal distribution in postherpetic neuralgia. C)Referred pain is spontaneous heterotopic pain felt at a site of pain with separate innervation to the primary source of pain. It is thought to be mediated by sensitization of interneurons located within the CNS. Pain referred from the sternocleidomastoid muscle to the temporomandibular joint is an example of referred pain [4]. The remainder of this article will focus on non-odontogenic pains of odontogenic origin.

The cardinal warning symptoms of nonodontogenic toothache are as :

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spontaneous multiple toothaches

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inadequate local dental cause for the pain

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stimulating, burning, nonpulsatile toothaches

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constant, unremitting, nonvariable toothaches

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persistent, recurrent toothaches

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local anesthetic blocking of the offending tooth does not eliminate the pain

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failure of the toothache to respond to reasonable dental therapy.

* The extent of pain may vary from very mild and intermittent pain to severe, sharp, and continuous -

Pains that are felt in the tooth do not always originate from dental structures

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In ‘primary’ pain, the site and source of pain are coincidental and in the same location

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Pain with different sites and sources of pain, known as heterotopic pains, can be diagnostically challenging