Chapter 032. Oral Manifestations of Disease (Part 8)

Migrainous neuralgia may be localized to the mouth. Episodes of pain and remission without identifiable cause and absence of relief with local anesthesia are important clues. Trigeminal neuralgia (tic douloureaux) may involve the entire branch or part of the mandibular or maxillary branches of the fifth cranial nerve and produce pain in one or a few teeth. Pain may occur spontaneously or may be triggered by touching the lip or gingiva, brushing the teeth, or chewing. Glossopharyngeal neuralgia produces similar acute neuropathic symptoms in the distribution of the ninth cranial nerve. Swallowing, sneezing, coughing, or pressure on the tragus...
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Chapter 032. Oral Manifestations of Disease (Part 8) Chapter 032. Oral Manifestations of Disease (Part 8) Migrainous neuralgia may be localized to the mouth. Episodes of pain andremission without identifiable cause and absence of relief with local anesthesia areimportant clues. Trigeminal neuralgia (tic douloureaux) may involve the entirebranch or part of the mandibular or maxillary branches of the fifth cranial nerveand produce pain in one or a few teeth. Pain may occur spontaneously or may betriggered by touching the lip or gingiva, brushing the teeth, or chewing.Glossopharyngeal neuralgia produces similar acute neuropathic symptoms in thedistribution of the ninth cranial nerve. Swallowing, sneezing, coughing, orpressure on the tragus of the ear triggers pain that is felt in the base of the tongue,pharynx, and soft palate and may be referred to the temporomandibular joint.Neuritis involving the maxillary and mandibular divisions of the trigeminal nerve(e.g., maxillary sinusitis, neuroma, and leukemic infiltrate) is distinguished fromordinary toothache by the neuropathic quality of the pain. Occasionally phantompain follows tooth extraction. Often the earliest symptom of Bells palsy in the dayor so before facial weakness develops is pain and hyperalgesia behind the ear andside of the face. Likewise, similar symptoms may precede visible lesions of herpeszoster infecting the seventh nerve (Ramsey-Hunt syndrome) or trigeminal nerve.Postherpetic neuralgia may follow either condition. Coronary ischemia mayproduce pain exclusively in the face and jaw and, like typical angina pectoris, isusually reproducible with increased myocardial demand. Aching in several uppermolar or premolar teeth that is unrelieved by anesthetizing the teeth may point tomaxillary sinusitis. Giant cell arteritis is notorious for producing headache, but it may alsoproduce facial pain or sore throat without headache. Jaw and tongue claudicationwith chewing or talking is relatively common. Tongue infarction is rare. Patientswith subacute thyroiditis often experience pain referred to the face or jaw beforethe tender thyroid gland and transient hyperthyroidism are appreciated. Burning mouth syndrome (glossodynia) is present in the absence of anidentifiable cause (e.g., vitamin B12 deficiency, iron deficiency, Plummer-Vinsonsyndrome, diabetes mellitus, low-grade Candida infection, food sensitivity, orsubtle xerostomia) and predominantly affects postmenopausal women. Theetiology may be neuropathic. Clonazepam, alpha-lipoic acid and cognitivebehavioral therapy have benefited some. Diseases of the Salivary Glands Saliva is essential to oral health. Its major components, water and mucin,serve as a cleansing solvent and lubricating fluid. In addition, it containsantimicrobial factors (e.g., lysozyme, lactoperoxidase, secretory IgA), epidermalgrowth factor, minerals, and buffering systems. The major salivary glands secreteintermittently in response to autonomic stimulation, which is high during a mealbut low otherwise. Hundreds of minor glands in the lips and cheeks secrete mucuscontinuously. Consequently, oral function becomes impaired when salivaryfunction is reduced. Dry mouth ( xerostomia ) is perceived when salivary flow isreduced by 50%. The most common etiology is medication, especially drugs withanticholinergic properties, but also alpha and beta blockers, calcium channelblockers, and diuretics. Other causes include Sjögrens syndrome, chronicparotitis, salivary duct obstruction, diabetes mellitus, HIV/AIDS, and irradiationfor head and neck cancer. Management involves eliminating or limiting dryingmedications, preventive dental care, and supplementing oral liquid. Sugarlessmints or chewing gum may stimulate salivary secretion if dysfunction is mild.When sufficient exocrine tissue remains, pilocarpine or cevimeline has beenshown to increase secretions. Commercial saliva substitutes or gels relieve drynessbut must be supplemented with fluoride applications to prevent caries. Sialolithiasis presents most often as painful swelling but in some instancesas just swelling or pain. The obstructing stone produces spasm upon eating.Conservative therapy consists of local heat, massage, and hydration. Promotion ofsalivary secretion with mints or lemon drops may flush out small stones.Antibiotic treatment is necessary when bacterial infection in suspected. In adults,acute bacterial parotitis is typically unilateral and most commonly affectspostoperative patients within the first 2 weeks of surgery. Staphylococcus aureusis the most common bacterial agent. Dehydration, advanced age, and chronicdebilitating disease are major risks. Chronic bacterial sialadenitis results fromlowered ...