MUCOGINGIVAL PAIN

8/9/2019 MUCOGINGIVAL PAIN

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MUCOGINGIVAL PAINS

DR.T.B.PHANINDHAR RAJ,

MSCD-ENDODONTICS,

2nd Yr,1st SEM


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INTRODUCTION

In the orofacial region, primary somatic pain of the superficial

type emanates from the skin of the Lips, Face, outer nares and

outer external auditory canal and from the mucogingival tissues

of the oral cavity.

Pains from these structures display clinical features that

distinguish them from primary deep somatic pains and from

secondary heterotopic manifestations of somatic andneuropathic pain disorder


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classification of orofacial pains


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MUCOGINGIVAL PAIN

Its a stinging or burning sensation,

It differ from cutaneous pain as it does not show the typical

pricking ,burning pattern of cutaneous pain and also the

number of thick fibers innervating the oral mucosa is

negilible as compared to that of skin.

The entire mucosa feels a stinging and burning sensation .

Pain arising from the oral tissues can be precisely located

by the patient. Some patient can be generalized through outthe mouth while some may be isolated.

Mucogingival pain is generalized, isolated, referred and

neurogenous


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GENERALIZED CONDITION

Local cause

Irritating effects of substances like food,

liquids,mouthwashes,dentiures and medicaments

Abrasive effects of excessive rubbing of the tongue and

cheeks ,trauma and infection by bacteria ,fungi ,viral

agents, allergy and neoplasm

Frequently signs of hyperemia, inflammation and someother pathosis can be seen at the site of pain.


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Glossodynia, burning mouth tongue

It may also cause steady ,continuous ,typical superficial

somatic pain .

The location of pain corresponds to the area of greatest

movement

Secondary infection starts in the tissues may complicate the

symptoms

Xerostomia may also cause this condition.


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Massive superficial injury

Traumatic effects from mechanical ,thermal or chemical

caliber's such as scalding with hot foods or liquids orexcessive smoking or use of tobacco, abrasion from tooth

brushes etc may cause pain.

Allergic responses Various allergic responses including stomatitis

medicamantosa and somatitis venenata may produce rather

generalized mucogingival pain.

These condition are usually accompanied by the objective

sign of tissues changes and the cause can be known by

careful history taking


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Stomattis venenata may occur from contact with

substances such as denture materials, dentifrices, mouthwashes, lozenges, lipsticks, topical medicaments and

flavoring materials.

Desquamation of the protective surface layer of epithelium

may occur ,revealing the deep vascular bed.

Stomatitis medicamentosa is an allergic reaction to

systemic medicaments such as antibiotics like

sulfonamides.


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Pregnancy

Pregnancy ,perhaps the injestion of oral contraceptives

drugs cause oral manifestation which may cause pain

Systemic diseases

Systemic diseases may casue oral manifestation that

effect the mucogingival tissues causing generalized

superficial somatic pain

Eg- nutritional deficiency ,intoxication, anemia,other blood

dyscarasis,pellagra,diabetes and pempigus


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Local effects

Wide spread local infection of mucogingival tissues cancause generalized superficial somatic pain,

Signsinflammation and ulceration make the pain obvious

Isolated mucogingival pain

Various isolated lesions like herpes simplex and ulceration

lesions of aphthous stomatits, ulcer from dental appliances

can cause mucogingival pain

Exostosis when severely traumatized can cause a fulthickness mucogingival ulcer and cause pain with deep

somatic characteristics.


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Referred pain

According to central excitatory theory, the input of deep painimpulses may stimulate other neurons that mediate pain

causing referred pain.

If that neurons mediate superficial pain impulse the referred

pain will have characteristic of superficial somatic pain.Thus, deep pain may be secondary induces mucogingival

pain.

Referred pain in the mucogingival tissues may occur as adirect result of deep pain source such as toothache

,earache ,sinusitis ,TMG ,arthralgia and vascular pain.


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Neurogenous mucogingival pain

It present clinical characteristics stimulating those of the

superficial somatic pain,

Eg-painful neuroma, neuralgia pain and neuritis pain.


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DIFFERENTIAL DIAGNOSIS

Heterotopic neuropathic pains

They may be projected superficially and present with

clinical features that stimulate superficial somatic pain.

Paroxysmal neuralgia

they may be triggered by stimulation of cutaneous or

mucogingival receptors in the peripheral distribution of the

same nerve that mediates the pain


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In trigeminal neuralgia, the sites of such triggering arepredominantly cutaneous, being located especially in the lips.

Mucogingival triggeringit occurs with tongue being a frequentsite.

Glossopharyngeal triggering-pharyngeal mucosa and pain isinduced by swallowing, talking and chewing.

Clinically criteria-the triggering for identifying mucosal triggeringof paroxysmal neuralgia has to do with the summation effectsdisplayed; the triggering provokes pain that is whollydisproportional to the stimulus.

Treatment-

analgesic blocking of the peripheral receptors of the affectednerve prevents the triggering effect of superficial stimulation

Topical anesthesia..


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Deafferentation pain

It become a complication sequential to trauma, surgery, tooth

extraction or tooth pulp extirpation.

The pain complaint may be accompanied by paresthesia,

dyesthesia, anesthesia, hyperesthesia or hyperalgesia in an

area larger than that innervated by the injured nerve. The symptoms may be accentuated by efferent sympathetic

activity involving vasomotor and glandular function.

Treatment-Analgesicblocking the stellate ganglion.


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Traumatic neuralgia or a neuroma

It is characterized by its location relative to prior injury or

surgery and by the specific induction of pain due tocompressing or stretching the tissue involved

Treatment

Local anesthetics


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Neuritis

That involves cutaneous and mucogingival structures may be

difficult to recognize because of its similarity to superficalsomatic pain

Neuropathic pain is its ongoing ,persistant, unremittingcharacters

The presence of other neural effects that may acompany theneuritis pain.

Neuritis of the facial nerve is characterized by paralysis offacial muscles.

Treatment-

Analgesicblocking the central to the site of neuropathyarrests the pain


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The primary superficial somatic pains felting the cutaneous

and mucogingival tissues of the orofacial area need to be

distinguished from the following Heterotopic referred pains, projected pains, secondary

hyperalgesias and autonomic effects that occur secondary

to deep somatic pain and neuropathic pains

Systemic illness

Heterotopic pains of central origin

Pains related to psychologic conditions


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THERAPEUTIC OPTIONS

Analgesics for palliative relief and counseling.

Cause-related therapy

1. Identification and treatment of etiology factors andcontributing condition present..

2. Elimination of all oral irritants3. Restriction of oral function within reasonable limits

4.Antibiotics and antimicrobials, topical and systemic

5.Antiviral agents esp. for initial episodes6. Xerostomiaelimination or reduction of saliva-depressing

drugs, chewing paraffin or gums to stimulate salivaryflow,use of saliva substitutes and or electric stimulation of

saliva


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Pharmacologic therapy

1. Topical anesthetics(liquid,ointment,lozenge)

2. Analgesics balms

3. Anti-inflammatory agents

Medical consultation


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Thank u all

Thank u all

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MUCOGINGIVAL PAIN