ABOP Orofacial Pain flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Trigeminal nerve divisions

V1 ophthalmic, V2 maxillary, and V3 mandibular; V3 is the only division carrying motor fibers to the muscles of mastication and several suprahyoid muscles.

TMJ disc composition

The temporomandibular joint disc is fibrocartilaginous rather than hyaline, allowing it to withstand compressive and shear forces during jaw function.

Maximum interincisal opening

Normal maximum interincisal opening is approximately 40-50 mm; values below 40 mm suggest restricted opening requiring further evaluation.

Spinal trigeminal nucleus

Orofacial pain afferents project to the spinal trigeminal nucleus; pars caudalis is the principal relay homologous to the spinal dorsal horn.

Hydrodynamic theory

Pulpal A-delta fibers are activated by rapid fluid movement within dentinal tubules, explaining sharp dentinal sensitivity to thermal and osmotic stimuli.

A-delta versus C fibers

A-delta fibers are thinly myelinated and mediate fast, sharp first pain; unmyelinated C fibers mediate slow, dull second pain.

Peripheral sensitization

Inflammatory mediators such as bradykinin, prostaglandins, substance P, and CGRP lower nociceptor threshold and increase firing after tissue injury.

Central sensitization

NMDA-dependent dorsal horn hyperexcitability expands receptive fields and produces hyperalgesia and allodynia after sustained nociceptive input.

Gate control theory

Large-fiber A-beta input and descending inhibition can suppress small-fiber nociceptive transmission in the dorsal horn, modulating perceived pain.

Convergence-projection

Deep and cutaneous afferents converge on shared second-order neurons, so deep or visceral pain is perceived as arising from a distant site.

Disc displacement with reduction

A reciprocal click with normal opening indicates the disc reduces during opening; intermittent locking may occur in the reducible subtype.

Disc displacement without reduction

Limited opening below 40 mm with deviation toward the affected side and a history of a click that ceased characterizes non-reducing disc displacement.

Myofascial pain diagnosis

Palpation of masticatory muscles reproduces familiar pain and may refer pain to distant sites, distinguishing myofascial pain from local myalgia.

DC/TMD axis II

Axis II of the DC/TMD screens for pain-related disability with the GCPS and psychological status with instruments such as the PHQ-4 and JFLS.

Arthralgia versus osteoarthritis

Arthralgia is joint pain with pain on palpation or function; crepitus with osseous change suggests degenerative joint disease (osteoarthritis).

ICHD-3 migraine criteria

Migraine is 4-72 hours of unilateral, pulsating, moderate-severe pain aggravated by activity, with nausea and/or photo- or phonophobia.

Tension-type headache

Bilateral, pressing or tightening, mild-moderate headache not aggravated by routine activity and without vomiting characterizes tension-type headache.

Cluster headache features

Severe unilateral orbital or temporal pain lasting 15-180 minutes with ipsilateral autonomic signs such as lacrimation, rhinorrhea, ptosis, and miosis.

Headache attributed to TMD

Headache in the temple region reproduced by palpation of the temporalis or masseter and resolving with TMD treatment is attributed to TMD.

Giant cell arteritis red flags

Age over 50 with new headache, jaw claudication, and elevated ESR or CRP requires urgent corticosteroids to prevent vision loss.

Trigeminal neuralgia features

Paroxysmal, electric-shock-like, unilateral facial pain triggered by light touch; classic type involves neurovascular compression at the root entry zone.

Trigeminal neuralgia first-line drug

Carbamazepine or oxcarbazepine is first-line pharmacotherapy for trigeminal neuralgia; baclofen or lamotrigine may serve as adjuncts.

Burning mouth syndrome

Intraoral burning with normal mucosa and no identifiable cause; secondary causes such as B12 deficiency, diabetes, candidiasis, and xerostomia must be excluded.

Persistent idiopathic facial pain

Continuous, poorly localized facial pain not explained by another disorder; it is a diagnosis of exclusion after thorough evaluation.

Sleep bruxism diagnosis

Sleep bruxism is diagnosed by EMG or by report plus clinical findings; tooth wear alone is insufficient because it reflects cumulative history.

Obstructive sleep apnea screening

STOP-BANG screens for obstructive sleep apnea; polysomnography remains the reference standard for diagnosis and severity grading.

Mandibular advancement device

An oral appliance that advances the mandible to enlarge the upper airway; used for mild-moderate OSA when CPAP is not tolerated.

Sleep and pain sensitivity

Poor sleep quality and insomnia amplify pain sensitivity and are risk factors for chronic TMD and headache.

TMJ MRI indications

MRI is the reference standard for evaluating disc position, joint effusion, and soft tissue; CBCT is preferred for osseous changes.

Range of motion assessment

Measure maximum interincisal opening and lateral and protrusive excursions; note deviation and joint sounds during opening and closing.

NSAIDs for acute TMD

NSAIDs such as ibuprofen or naproxen are first-line for acute TMD pain; screen for gastrointestinal, renal, and cardiovascular risk before use.

Cognitive behavioral therapy

CBT reduces pain catastrophizing and improves coping in chronic TMD and orofacial pain; it is a core component of multidisciplinary care.