Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, New York.
Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, New York.
J Endod. 2019 Dec;45(12S):S28-S38. doi: 10.1016/j.joen.2019.05.010. Epub 2019 Oct 14.
Trauma or injury to the dentition and supporting tissues is associated with pain and discomfort, as expected, that may present immediately, shortly afterwards, or within a few days. Pain is an essential response to injury because it allows the organism to develop avoidance behavior to potential threats and helps the organism to avoid usage of the injured organ during the healing process. Not only does external trauma induce pain, but also essential invasive dental procedures such as extractions, dental implant insertions, root canal treatments, and oral surgeries are accompanied by similar post-surgical (post-traumatic) pain. The pain intensity after trauma varies and does not always correlate with the extent of injury. Trauma to the orofacial region or the teeth may also indirectly affect and induce pain in other orofacial structures such as the masticatory muscles, the temporomandibular joint, and even the cervical spine. In most cases, the pain will resolve as soon as healing of the affected tissue occurs or after dental and routine palliative treatment. In a limited number of cases, the pain persists beyond healing and evolves into a chronic pain state. Chronic pain in the orofacial region presents diagnostic and management challenges. Misdiagnosis or delayed diagnosis of the oral chronic pain condition may lead to unnecessary dental treatment. This article will discuss diagnosis and treatment for acute and chronic pain as well as potential mechanisms involved in the undesirable transition from acute to chronic pain.
牙和支持组织的创伤或损伤通常会导致疼痛和不适，这些疼痛和不适可能会立即出现，也可能在受伤后不久或几天后出现。疼痛是对损伤的一种重要反应，因为它使机体能够形成对潜在威胁的回避行为，并有助于机体在愈合过程中避免使用受伤器官。不仅外部创伤会引起疼痛，而且一些必要的侵入性牙科手术，如拔牙、种植牙植入、根管治疗和口腔手术，也会伴随着类似的术后（创伤后）疼痛。创伤后的疼痛强度各不相同，并不总是与损伤程度相关。口腔颌面部区域或牙齿的创伤也可能会间接影响和引起咀嚼肌、颞下颌关节甚至颈椎等其他口腔结构的疼痛。在大多数情况下，一旦受影响的组织愈合，或者在进行了牙科和常规姑息治疗后，疼痛就会消失。在少数情况下，疼痛会持续到愈合之后，并发展为慢性疼痛状态。口腔颌面部的慢性疼痛存在诊断和管理方面的挑战。口腔慢性疼痛状况的误诊或延迟诊断可能会导致不必要的牙科治疗。本文将讨论急性和慢性疼痛的诊断和治疗，以及从急性疼痛向慢性疼痛不良转变的潜在机制。
