67 - Lip-Tilt
Hoofdstuk 67 - Paragraaf 4
67. Lip-Tilt

67.4 Paradontologics

Dr. Geerten-Has E.Hakkes

Orofacial Pain
Orofacial pain is a common reason for a patient to visit the physician or dentist. In most cases, diagnosis will be relatively straightforward and an adequate treatment can usually be provided. When pain persists over time (i.e., when pain becomes chronic), this will hamper the diagnostic process by so called neuroplastic changes of the nervous system.

Because of these physiological and biochemical changes, a normally non-painful stimulus may be perceived as painful. Neuroplastic changes may also explain the phenomenon of referred pain, i.e. pain is received in an area that is different from the source from where it originates.

Moreover, chronicity leads to an increased involvement of psychosocial factors in the perception and experience of pain, which further complicates the problem.

To diagnose pain, different classification systems have been developed. In these classifications, the pain conditions are usually described in terms of symptomatology. When the clinical presentation of symptoms becomes less clear, e.g. because of changes related to chronicity, classification will be more difficult. This will eventually have consequences for pain management. Especially for this patient group, there is a need for additional diagnostic information which may clarify the clinical picture. He aim of this thesis is to enhance the diagnostic assessment of chronic orofacial pain.

Tissue damage
Irrespective of the complexity of the pain, it will essentialy originate from actual or former tissue damage. This stimulus is subsequently processed within the the nervous system and will eventually give rise to certain responses, i.e. pain experience and behavior (consequenses). Thus, in the pain process essentially three components are involved:

Stimulus, Processing and Consequences. We therefore introduce the stimulus-processing-consequences (SPC) model as a starting point for the assessment of pain.

Acute pain
In most patients pain with acute pain, tissue damage plays a major role, while the processing of the stimuli is unaffected. Therefore, diagnosis and treatment of these patients will mainly focus on the stimulus. In patients with chronic pain, tissue damage will play a less dominant role and the consequences will largely be accompanied by changes in the processing of the stimuli. In this group, it is therefore important to not solely focus on the stimulus (the origin and extent of tissue damage), but to include explicitly the processing of the stimulus and its consequences in the diagnostic assessment.

Pain is, by defintion, an individual experience and is associates with tissue damage.Hoewever, somatic lesions usually are far less obvious in chronic pain than in acute pain conditions, and in many chronic pain cases a somatic lesion may not even exist any more at the time of examinatyion. O the other hand, psychosicial factors play a major role in chronic pain conditions. As a consequence , diagnostic assessment in chronic pain is difficult and complex.

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67.4 Paradontologics