Today I’d like to look at a few disorders which are chronic and can cause a variety of pains or disabilities.
Oral, dental, or craniofacial signs and symptoms play a critical role in autoimmune disorders such as Sjögren’s syndrome and in a number of similar conditions.
Sjögren’s syndrome is one of several autoimmune disorders in which the body’s own cells and tissues are mistakenly targeted for destruction by the immune system and is more prevalent among women.
The disease occurs in two forms: Primary Sjögren’s involves the salivary and lachrymal (tear) glands; Secondary Sjögren’s, where the glandular involvement is accompanied by the development of a connective tissue or collagen disease.
The glandular involvement causes a marked reduction in fluid secretion, resulting in xerostomia and xerophthalmia (dry eyes) and constant oral dryness that causes difficulty in speaking, chewing, and swallowing. There is currently no cure for Sjögren’s.
Clinically, the reduction in salivary flow changes the bacterial flora, which, in addition to the reduction in salivary protective components, increases the risk of caries and candidiasis.
Recent studies have indicated there is a reduction in masticatory function and an increased prevalence of periodontal disease.
In advanced stages the salivary glands may swell because of obstruction and infection or lymphatic infiltration.
Acute and Chronic Oral-Facial Pain
Since the nineteenth century, when two dentists, Horace Wells and Frederick Morton, demonstrated the analgesic powers of nitrous oxide and ether, oral health investigators have been recognized leaders in the field of pain management worldwide.
Their analyses of the cells, pathways, and molecules involved in the transmission of pain have given rise to a growing variety of medications, often combined with other approaches, which can control acute and chronic pain.
Atypical Facial Pain
Atypical facial pain is characterized by a continuous dull ache on one or both sides, most frequently in the region of the maxilla (the upper jaw).
The pain tends to be episodic and is aggravated by fatigue, worry, or emotional upset.
Tic Douloureux
The most frequently encountered of oral facial neuralgias is tic douloureux, or trigeminal neuralgia, a disease of unknown aetiology, affecting one, two, or all three branches of the trigeminal nerve.
The pain is highly intense, of a stabbing nature that lasts for a few seconds.
Temporomandibular Disorders
Various etiological factors, including trauma, can give rise to pain and dysfunction in the temporomandibular joint and surrounding muscles, conditions collectively called temporomandibular disorders (TMDs).
The pain may be localized or radiate to the teeth, head, ears, neck, and shoulders. Abnormal grating, clicking, or crackling sounds, known as crepitus, in the joint often accompany localized pain.
Pain is also found in response to clinical palpation of the affected structures.
I welcome anyone with firsthand experience of dealing with these disorders to get in touch and discuss how they’ve handled them in their dental practice.
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