7/27/2019 Chronic Oral Sensory Disorder

1/13

E R N A S U L I S T Y A N I

Chronic Oral Sensory Disorder

Pain and Abnormalities of Taste

7/27/2019 Chronic Oral Sensory Disorder

2/13

Chronic Orofacial Pain

Persistent pain in some cases without physicalabnormalities.

Presistent pain bisa terkait dengan faktor trauma,infeksi, neoplasia, gangguan metabolisme, gangg.

Neurogenic. Inflamasi, dan psikitatrik. The nervous system can no longer be regarded as a

simple feed-forward relay for sensory stimuli. It must beconsidered a complex transducer, processor, interpreterand pathologic generator. It is a highly reactive systemand on a occasion may react inappropriate andunfavorable ways.

Pain = Nyeri

7/27/2019 Chronic Oral Sensory Disorder

3/13

Taxonomy of Pain

Definition : Pain is unpleasant sensory andemotional experience associated with actual or

potential tissue damage, or describe in terms of suchdamage.

Pain is always subjective.

Pain in the absence of tissue damage usually

happens for psychological reasons.

7/27/2019 Chronic Oral Sensory Disorder

4/13

Allodynia: sakit oleh krn stimulus yg normalnya tdkmenyebabkan sakit.

Hyperalgesia: peningkatan respon thdp stimulus ygmemang sakit.

Hyperesthesia: peningkatan respon terhadap sesuatuyang mengganggu (bukan sakit ) misalnya suhu,getaran)

Hyperpathia: painfull syndrome, peningkatan reaksithdp stimulus, peningkatan ambang rasa sakit, tidak

bisa mengidentifikasi dan menunjukkan lokasistimulus, berlangsung lama dan menyebar.

7/27/2019 Chronic Oral Sensory Disorder

5/13

Causalgia: syndrome burning pain, allodynia andhyperpathia after traumatic nerve lesion.

Hypoesthesia:decrease sensitivity to stimulation Hyphoalgesia: response to a normally painfull stimulus is

diminished. Neuralgia: pain in the distribution of nerve. Neuropathy: Disturbance of function or pathologic

change of nerve. Nociceptor: pheripheral receptors preferentially sensitive

to noxious stimuli. Parasthesia: abnormal (but not unpleasent sensation)

whether spontaneous or evoked

7/27/2019 Chronic Oral Sensory Disorder

6/13

Dysesthesia: An unpleseant abnormal sensation.

Anesthesia dolorosa: Paradoxic pain in a region ofsensory loss following an injury to a cranial nerve or

nerve root. Central Pain: pain associated with a lesion of CNS.

7/27/2019 Chronic Oral Sensory Disorder

7/13

Evaluation of patient with chronic orofacial pain.History

Chief complaint and history of present illness.

Kata2 yg digunakan ut menggambarkan rasa sakit yangdirasakan, onset, progress, dampak terhadap pekerjaanmaupun hubungan sosial,

Dari riwayat rasa sakit ini kadang diagnosa bisa dibuat ataudipersempit.

Hal yg perlu dicatat, intensitas, kualitas, lokasi, onset,lamanya. Faktor yg meringankan dan meningkatkan rasa sakit

dsb. Informasi yg terkait dengan onset rasa sakit tersebut harus

digali lebih mendalam. Spt kesehatan psikis dan fisik,perubahan link kerja, keluarga dan lingkungan sosial.

7/27/2019 Chronic Oral Sensory Disorder

8/13

Intensitas : kuat ringan rasa sakit. fluktuasi rasasakitspontan, waktu tertentu, aktivitas atau posture.Kebiasaan2 mengunyah permen karet, clenching dangrinding yg kadang tdk disadari px.

Efect dari eating distraction, rest, exercise, heat andcold on pain.

Penyebaran rasa sakit perlu juga dideterminasi dengan

jelas. pusat rasa sakit dan penyebarannya.

7/27/2019 Chronic Oral Sensory Disorder

9/13

Past medical history

Some chronic pain are associated with systemicillness.

Current medical use, OTC, obat dgn resep, obat@

rumahan, allergi obat dan adverse reaction. Bbrp obat mempunyai efek samping yg berperan

dalam tjdnya rasa sakit spt fatique, dizzines, anxiety,insomnia, parasthesia and frank tissue iritation.

7/27/2019 Chronic Oral Sensory Disorder

10/13

Family, social and occupational history.

Penyakit pd keluarga atau saudara sedarahmengindikasi adanya faktor lingkungan atauherediter.

Faktor lain: marital status, education, pekerjaan,emotional stressfull event mungkin berhubungandengan penyebab rasa sakit itu.

7/27/2019 Chronic Oral Sensory Disorder

11/13

Physical examination

Pemeriksaan fisik bisa mengindentifikasi perubpathologis atau pd byk kasus membantu diagnosis

yang diambil saat anamnesis.

Meskipun tidak ada kelainan yg ditemukanpemeriksaan klinis tetap harus dilakukan utmenyingkirkan dugaan adanya kelainan2 yg serius.

Sensory discrimination, muscle strength, range of

motion, soft tissue palpation, intraoral exam, TMJauscultation and palpation and complete cranialnerve exam,

7/27/2019 Chronic Oral Sensory Disorder

12/13

Sensory discrimination, Tested with small sterileneedle or pin yg dimasukkan kedalam kulit sesuaidgn dermatomenya. Mata pasien terpejam.

Asymetric respons, hyperalgesia, hypoalgesia dicatat.

Muscle strength: evaluated by isometric contractionmuscless and palpation.

Range of motion: movement that elicit pain and non

painfull movement.

7/27/2019 Chronic Oral Sensory Disorder

13/13