ERNA SULI STYANI

Chronic Oral Sensory Disorder

Pain and Abnormalities of Taste
Chronic Orofacial Pain
Persistent pain in some cases without physical
abnormalities.
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 be
considered a complex transducer, processor, interpreter
and pathologic generator. It is a highly reactive system
and on a occasion may react inappropriate and
unfavorable ways.
Pain = Nyeri
Taxonomy of Pain

Definition : Pain is unpleasant sensory and
emotional experience associated with actual or
potential tissue damage, or describe in terms of such
damage.
Pain is always subjective.
Pain in the absence of tissue damage usually
happens for psychological reasons.
Allodynia: sakit oleh krn stimulus yg normalnya tdk
menyebabkan sakit.
Hyperalgesia: peningkatan respon thdp stimulus yg
memang sakit.
Hyperesthesia: peningkatan respon terhadap sesuatu
yang mengganggu (bukan sakit ) misalnya suhu,
getaran)
Hyperpathia: painfull syndrome, peningkatan reaksi
thdp stimulus, peningkatan ambang rasa sakit, tidak
bisa mengidentifikasi dan menunjukkan lokasi
stimulus, berlangsung lama dan menyebar.



Causalgia: syndrome burning pain, allodynia and
hyperpathia 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

Dysesthesia: An unpleseant abnormal sensation.
Anesthesia dolorosa: Paradoxic pain in a region of
sensory loss following an injury to a cranial nerve or
nerve root.
Central Pain: pain associated with a lesion of CNS.
Evaluation of patient with chronic orofacial pain.
History
Chief complaint and history of present illness.
Kata2 yg digunakan ut menggambarkan rasa sakit yang
dirasakan, onset, progress, dampak terhadap pekerjaan
maupun hubungan sosial,
Dari riwayat rasa sakit ini kadang diagnosa bisa dibuat atau
dipersempit.
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.
Intensitas : kuat ringan rasa sakit. fluktuasi rasasakit
spontan, waktu tertentu, aktivitas atau posture.
Kebiasaan2 mengunyah permen karet, clenching dan
grinding yg kadang tdk disadari px.
Efect dari eating distraction, rest, exercise, heat and
cold on pain.
Penyebaran rasa sakit perlu juga dideterminasi dengan
jelas. pusat rasa sakit dan penyebarannya.
Past medical history
Some chronic pain are associated with systemic
illness.
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.
Family, social and occupational history.
Penyakit pd keluarga atau saudara sedarah
mengindikasi adanya faktor lingkungan atau
herediter.
Faktor lain: marital status, education, pekerjaan,
emotional stressfull event mungkin berhubungan
dengan penyebab rasa sakit itu.
Physical examination
Pemeriksaan fisik bisa mengindentifikasi perub
pathologis atau pd byk kasus membantu diagnosis
yang diambil saat anamnesis.
Meskipun tidak ada kelainan yg ditemukan
pemeriksaan klinis tetap harus dilakukan ut
menyingkirkan dugaan adanya kelainan2 yg serius.
Sensory discrimination, muscle strength, range of
motion, soft tissue palpation, intraoral exam, TMJ
auscultation and palpation and complete cranial
nerve exam,
Sensory discrimination, Tested with small sterile
needle or pin yg dimasukkan kedalam kulit sesuai
dgn dermatomenya. Mata pasien terpejam.
Asymetric respons, hyperalgesia, hypoalgesia dicatat.
Muscle strength: evaluated by isometric contraction
muscless and palpation.
Range of motion: movement that elicit pain and non
painfull movement.