Differential Diagnosis of Orofacial Pain

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Differential Diagnosisof Orofacial Pain

• By
• S. Wanachantararak

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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

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Vascular Origin Orofacial Pain

• Migraine Headache
• Cluster Headache
• Peroxymal hemicrania
• Vascular Headache

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History Examination ofOrofacial Pain
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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

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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
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Clinical Examination of Orofacial Pain
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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

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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

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Pain from Intraoral Origin
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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Pain for Intraoral Origin
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Pain for Intraoral Origin
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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Pain for Intraoral Origin
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Pain for Intraoral Origin
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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Pain for Intraoral Origin
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Pain for Intraoral Origin
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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Pain for Intraoral Origin
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Pain for Intraoral Origin
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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Pain for Intraoral Origin
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Pain for Intraoral Origin
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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis
• Pain from oral mucosa

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Pain for Intraoral Origin
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Pain for Intraoral Origin
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Non Vascular OriginOrofacial Pain
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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

40
Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

43
Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

46
Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

49
Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

52
Non Vascular Origin Orofacial Pain
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Non Vascular Origin Orofacial Pain
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Vascular OriginOrofacial Pain
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Vascular Origin Orofacial Pain

• Migraine Headache
• Cluster Headache
• Peroxymal hemicrania
• Vascular Headache

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Vascular Origin Orofacial Pain

• Migraine Headache
• Cluster Headache
• Peroxymal hemicrania
• Vascular Headache

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Vascular Origin Orofacial Pain
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Vascular Origin Orofacial Pain
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Vascular Origin Orofacial Pain

• Migraine Headache
• Cluster Headache
• Peroxymal hemicrania
• Vascular Headache

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Vascular Origin Orofacial Pain
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Vascular Origin Orofacial Pain
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Vascular Origin Orofacial Pain

• Migraine Headache
• Cluster Headache
• Peroxymal hemicrania
• Vascular Headache

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Vascular Origin Orofacial Pain
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Vascular Origin Orofacial Pain
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Vascular Origin Orofacial Pain

• Migraine Headache
• Cluster Headache
• Peroxymal hemicrania
• Vascular Headache

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Vascular Origin Orofacial Pain
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Vascular Origin Orofacial Pain
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Pain for Intraoral Origin

• Pain from Dentine
• Pain from Pulp
• Pain from Gingiva
• Pain from Periodontatitis
• Pain from Periapical periodontitis

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Non Vascular Origin Orofacial Pain

• Pain from Teeth (pulp)
• Pain from TM muscle
• Pain from TMJ
• Sinusitis
• Salivary gland
• Trigeminal Neuralgia
• Atypical Neuralgia

70
Vascular Origin Orofacial Pain

• Migraine Headache
• Cluster Headache
• Peroxymal hemicrania
• Vascular Headache

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