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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