صفحه 1:
صفحه 2:
European Congress of Homeopathy — May 18-21, 2011, Riga, Latvia
Orofacial Neuralgia-Clinical cases >
Homeopathy
Treatment
- local immunity stimulation
Aphrodite Chatzimanuil DDS President of Hellenic Classical Homeopathic
Dental Association, NHS Greece
Mighalakis Michail. DDS, MSc. Specialized in Oral Radiology Member
HCHBA,EADMFR, scientific commi
صفحه 3:
© 22% of the U.S. population have orofacial pain incidence
on more than 1 occasion in a 6-month period.1
© However, the etiology of pain for countless patients
who have chronic orofacial pain disorders is unknown.
© Although pain involving the teeth and the periodontium is
the most common presenting concern in dental practice,
other nonodontogenic causes of orofacial pain must be
considered in the differential diagnostic process.
Treatment Dilemmas are not rare for both physician and
the practicing dentist since
© Trigeminal neuralgia mimicks odontogenic pain.2,3
Many acute, chronic, and recurrent painful maladies
manifest in the orofacial region.
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79 TN = douloureux 5
© Pain distribution is unilateral. —
© Typically radiating along maxillary
(V2),mandibular (V1) branche
© Rarely both L GR sides r affected
© FQ International 155cases/million
© 2:3 ratio male/female ۱ \
© Observed >5th decade
© DD: multiple sclerosis, TMJ
syndrome, post-herpetic neuralgia,
Atypical facial pain, glossopharyngeal
neuralgia, aneurysms, tumors,
Compression of trigeminal roots,
chronic meningeal inflammation,
Dental problems..
© Signs of neurologic abnormality
exclude the idiopathic diagnosis.
© Mechanism of pain production
remains controversial.
fore eet)
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١ “Ist case 9 80 years old-H:1,67, W: 72 kg Proceded
with chronic complain of facial painteft{Aphrodite
chatzimanuil)
-Diagnosed wiyh TN at 1997 NHS Greece, on
medication since (Tegretol/200mg 1x3/day and
then 3x3 for 6months)
-Medical anamnesis: 2 birth deliveries.
۰1979 Removal of phalopian tube due to
inflammation
-2002: Knee surgery (pnén pnvioKkov)
trigeminal pain began at 1997. as mild
irritation that were intensified in time.
-edentulous
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0 9
“with chronic complain of facial-pain left (Aphrodite
8coutziwianuhe seeks homeopathy.
Patient description: Like a penetration of needle that electric current
was going through
‘Couldn't eat or speak«Acv pnopovea va paw, Sev propotoa va
UAT ow».
Antensity was greater in the morning, ameliorated when chewing hard
(4). Sleeps on side
- desires order and quiet (3), Mild personality, withstands pain, patient
and consistent personality
“Desires to be in open space (amel) (2)
Sensitive to wind currents (Agr).
Des: pasta (3) sweet (2)
-Avers: Vegies (3)
anxious about kids, uncomfort in narrow places clystofobia
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۳ tially took constitutionally remedy Magnesia Phosp. 1Mx10,
Follow up ,Feb 2009 Magnesia Phosp. 1Mx4, follow up
ameliorated other pathology
-08/2007: prescribed with Magn. Phosporica
1Mx10 days. Pain ameliorated gradually to
complete within a period of a month.
-02/2009: recurrence of pain with less intensity,
time duration & intervals. prescribed with
Magn.Phosporica 1M x4days.
-2009: knee arthitis (Tevixy 12000171
vyetac: KAAH)
°1/2011 no complaint reported, knee irritations
ameliorated as well.
-Didn’t want to speak about it.. again
صفحه 8:
© Neuropathic orofacial pain, which
is pain initiated or caused by a
primary lesion or dysfunction in the
nervous system, is relatively
common. It is diagnosed in
approximately 25% to 30% of
patients presenting in a tertiary care
University-based Facial Pain
Center.2
© using MRI&MRA (angiography to
show compression of V n. close to
brain stem) routine imaging
© Odontogenic orofacial pain mimic
TN thus treated as idiopathic due to
incomplete diagnosis
“nonodontogenic toothache-neuralgia
©The key symptoms of nonodontogenic
toothache are as follows:4
spontaneous multiple
toothaches;
inadequate local dental cause
for the pain;
stimulating, burning,
nonpulsatile toothaches;
constant, unremitting,
nonvariable toothaches;
persistent, recurrent toothaches;
local anesthetic blocking of
the offending tooth does not
eliminate the pain;
failure of the toothache to
respond to reasonable dental
therapy.4
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"2۳0 256 9 74۷/65۲5۵۱۵ ۲:1,69, W: 58 kg
Proceded with chronic complain of facial pain right
side (Michalakis michail)
® Diagnosed TN in
France at 1996 and
treated homeopathic
with aconite at 1998
© but pain recurrent at
2006( received several
remedies ) at 2007
finally Sepia
ameliorated symptoms.
® since 2008 on T4
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© 2009 used cortisol-antidote.
© 11-2010 in radiology exam
appeared dentoalveolar
pathology in proximity to 3rd
brance of V n. Referred to
endondic-specialist
© 27 feb completed root canal at
tooth 46....(notes...)
© Diagnostic observations in
several homeopathic cases.
Understanding dental pulp
pathology will clear out to the
prescriber the necessity for
diagnosis throughout such
cases.
صفحه 11:
23-11-2010 Ms MyA-M
Following a radiology exam appears to have cystic formation at the
root apex of:
‘Tooth 47 largeS. well organized (possible granuloma). (Marked A1)
In Tooth No 46 the formation appears to be distal ( marked A2) in
the intermediate space-bone of 46-47 applying pressure to the
inferior alveolar canal & passing through nerve. (marked as Alv.n)
A dental CT for this area is required if pain pathology reappear... 19-1-2011 0 tévoc EeKtvovgEe
ané to A 2 (46) oto péonua pe avtidpaon otHy Enixpovon, SvoKoria
Katdnoons, oteyvavet o Acids. A) Ref : yta evbobovtia
صفحه 12:
Although the etiology and pathophysiology of odontogenic
pain is well known (ie, bacteria-induced destruction of tooth
structure and subsequent activation of tooth nociceptors),
mechanisms underlying trigeminal neuralgia are less
صفحه 13:
Trigeminal neuralgia mimicks odontogenic pain یی
trigeminal neuropathic pain may exist in many forms and may
easily be mistaken to represent one of odontogenic source.
Ladies >5th decade are frequent candidates.
© The pitfall for the practicing dentist is to focus on the
odontogenic pain component,while the physician focuses on
the trigeminal neuropathic pain component.
°Failure to identify the source of the patient’s entire
problem may lead to erroneous and ineffective treatment.
©Therefore, it is important to consider all sources of pain in
trying to delineate the etiology and ultimately recommend
treatment.
صفحه 14:
© Optimum management can only be achieved
by determining an accurate complete
Diagnosis_ identifying all of the factors
associated with the underlying pathology on a
case-specific basis.
Untreated inflammatory process in the
jaws can be harmful in a systemic way,
shadowed with a latent period of time.
صفحه 15:
ل 86۲۲6۲6۲6
© 1. Lipton JA, Ship JA, Larach-Robinson D: Estimated prevalence
and distribution of reported orofacial pain in theUnited States. J Am
Dent Assoc 124:115-121, 1993
2. Toothache or Trigeminal Neuralgia: Treatment Dilemmas Christopher
J. Spencer, John K. Neubert, Henry Gremillion, Joanna M. Zakrzewska,and Richard
Ohrbach The Journal of Pain, Vol 9, No 9 (September), 2008: pp 767-770
19. Gremillion HA: Neuropathic orofacial pain: proposed
mechanisms, diagnosis, and treatment considerations. Dent Clin North Am
51:209-224, 2007
3. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Jul;80(1):96-100.
‘Trigeminal neuralgia mimicking odontogenic pain. A report of two cases.
Law AS, Lilly JP. Department of Endodontics, University of lowa College of Dentistry,
Iowa City, USA.
© 4. Tex Dent J. 2000 Jul;117(7):64-74.Nonodontogenic toothache.Okeson JP.
Orafacial Pain Center, University of Kentucky, College of Dentistry, USA
صفحه 16:
Conditions representative of neuropathic
orofacial pain are postherpetic neuralgia,
trigeminal neuralgia, traumainduced
neuropathy, atypical odontalgia /
nonodontogenic toothache, idiopathic oral
burning, and Complex Regional Pain
Syndrome (CRPS),
In some instances, diagnosis can be
difficult, as neuropathic orofacial pain is
associated with significant interpatient
variability regarding presentation and response
to treatment. Additionally, neuropathic pain
conditions are frequently associated with
qualities that the patient is not familiar
thus making it difficult for the patient to
communicate their pain experience.
‘Typical descriptors used by patients include
stabbing, burning, electric-like, and/or
sharp, with numbness or tingling projected
to a cutaneous area. 15,16 However, aching
pain does not preclude the possibility of a
neuropathic basis for the patient's pain.
clinician must decide whether the 2 pain
complaints (tooth vs neuropathic pain) are
related or are merely coincidental. Such co
morbid conditions may result in diagnostic
confusion and a perpetuation of the
patient’s pain condition.
‘Many acute, chronic,
and recurrent painful
maladies manifest in
the orofacial region.
Lipton et al 11
reported that 22% of
the U.S. population
have orofacial pain on
more than 1 occasion
in a 6-month period.1
صفحه 17:
‘However, the etiology of pain for countless
patients who have chronic orofacial pain
disorders is unknown.
* patients may not recognize an injury or
serendipitously report having a relatively minor
dental procedure (eg, restoration or root canal)
completed at the time of pain onset.
‘Although pain involving the teeth and the
periodontium is the most common presenting
concern in dental practice, other
nonodontogenic causes of orofacial pain must
be considered in the differential diagnostic
process.
صفحه 18:
*Neuropathic orofacial pain, which is pain
initiated or caused by a primary lesion or
dysfunction in the nervous system, is
relatively common. It is diagnosed in
approximately 25% to 30% of patients
presenting in a tertiary care University-
based Facial Pain Center.