Routine diagnostic studies include a CBC, sedimentation rate, chemistry panel, arthritis panel, and an x-ray of the teeth and jaw. X-ray of the sinuses may be helpful. At this point referral to a dentist or oral surgeon should be made if there is still diagnostic difficulty. He may order an MRI of the temporomandibular joint, which is the procedure of choice in evaluating this joint. If all tests are negative or equivocal, perhaps a psychiatric referral is in order.
Dental or periodontal pathology
–Associated with temperature sensitivity and pain upon biting
- TMJ disorders
–Associated with unilateral or bilateral achy pain and diffuse tenderness of the masseter and temporalis muscles
–Exaggerated by jaw use
–Joint may be tender to palpation
–“Clicking” sounds are often present
–More common in females age <50
-
Giant cell (temporal) arteritis
–Unilateral pain in older patients
–Headache, jaw claudication, and vision loss
-
Mucosal lesions (buccal mucosa, hard and soft
palate, floor of mouth, or oropharynx)
–Aphthous ulcers
–Herpes simplex or coxsackievirus B
–Cancer
–Tongue or lip lesions
-
Paranasal sinus pathology
–Most common pathology is maxillary
sinusitis secondary to viral URI
–Pain is often referred to the upper molars
-
Salivary gland pathology, including inflammation (e.g., parotiditis), ductal stone, or neoplasm
-
Headache with radiation to the jaw
-
Referred pain from cardiac, cervical spine, pulmonary, or throat disease
-
Neuralgias (e.g., trigeminal, glossopharyngeal)
-
Neuropathies
–Systemic neuropathies (e.g., HIV, diabetes)
–Dental/alveolar neuropathies, usually
subsequent to extrinsic trauma (e.g., blow to face, dental surgical intervention)
-
Behavioral disorders
-
Primary neoplasms of the maxilla, mandible, or major salivary gland
-
Metastases to mandible, maxilla, or TMJ
-
Herpes zoster or post-herpetic neuralgia
-
Fibromyalgia
-
Rheumatologic disease (e.g., Sjögren's syndrome)
-
Systemic arthritis (e.g., rheumatoid arthritis)
Workup and Diagnosis
- History and physical examination, with focus on the head and neck
–Review onset, character, and pattern of pain; past medical and surgical history; associated symptoms (e.g., weight loss, sinus pain, skin complaints); and complete review of systems, including screening for local and systemic pathology and a cervical evaluation for muscle, neural, or skeletal referred pain
–Perform a thorough oral exam of the buccal mucosa, lips, hard palate, soft palate, posterior pharynx, floor of mouth, and the top, sides, and undersurface of the tongue
–Perform a head, neck, ear, nose, cardiac, pulmonary, and lymphatic exam
–Suspect dental pathology until proven otherwise
-
Initial workup is aimed at assessing the mouth and jaw for dental, periodontal, or TMJ disorders
-
Appropriate laboratory studies are based upon the suspected diagnosis (e.g., CBC and ESR for temporal arteritis)
-
Imaging studies may include Panorex films, sinus X-ray, CT scan, and/or MRI
-
Therapeutic trial of medications (e.g., NSAIDs)
-
Temporal artery biopsy is indicated if ESR elevated
-
Biopsy any suspicious lesion
-
Referral to a dental or medical specialist may be necessary
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» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Carpopedal spasm:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient isn't in distress, obtain a detailed history. Ask about the onset and duration of the spasms and ask for a description of pain they produce. Also ask about related signs and symptoms of hypocalcemia, such as numbness and tingling of the fingertips and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Check for previous neck surgery, calcium or magnesium deficiency, tetanus exposure, and hypoparathyroidism.
During the history, form a general impression of the patient's mental status and behavior. If possible, ask family members or friends if they've noticed changes in the patient's behavior. Mental confusion or even personality changes may occur with hypocalcemia.
Inspect the patient's skin and fingernails, noting dryness or scaling and ridged, brittle nails.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Jaw pain:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin the patient history by asking him to describe the pain’s character, intensity, and frequency. When did he first notice the jaw pain? Where on the jaw does he feel pain? Does the pain radiate to other areas? Sharp or burning pain arises from the skin or subcutaneous tissues. Causalgia, an intense burning sensation, usually results from damage to the fifth cranial, or trigeminal, nerve. This type of superficial pain is easily localized, unlike dull, aching, boring, or throbbing pain, which originates in muscle, bone, or joints. Also ask about aggravating or alleviating factors.
Ask about recent trauma, surgery, or procedures, especially dental work. Ask about associated signs and symptoms, such as joint or chest pain, dyspnea, palpitations, fatigue, a headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss. (Keep in mind that jaw pain may accompany more characteristic signs and symptoms of life-threatening disorders such as chest pain in a patient with an MI.)
Focus your physical examination on the jaw. Inspect the painful area for redness, and palpate for edema or warmth. Facing the patient directly, look for facial asymmetry indicating swelling. Check the TMJs by placing your fingertips just anterior to the external auditory meatus and asking the patient to open and close, and to thrust out and retract his jaw. Note the presence of crepitus, an abnormal scraping or grinding sensation in the joint. (Clicks heard when the jaw is widely spread apart are normal.) How wide can the patient open his mouth? Less than 1 ⅛" (3 cm) or more than 2⅜" (6 cm) between the upper and lower teeth is abnormal. Next, palpate the parotid area for pain and swelling, and inspect and palpate the oral cavity for lesions, elevation of the tongue, or masses.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Carpopedal spasm:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient isn’t in distress, obtain a detailed history. Ask about the onset and duration of the spasms and the degree of pain they produce. Also ask about related signs and symptoms of hypocalcemia, such as numbness and tingling of the fingertips and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Check for previous neck surgery, calcium or magnesium deficiency, tetanus exposure, and hypoparathyroidism.
During the history, form a general impression of the patient’s mental status and behavior. If possible, ask family members or friends if they’ve noticed changes in the patient’s behavior because hypocalcemia can cause confusion and even personality changes.
Inspect the patient’s skin and fingernails, noting any dryness or scaling and ridged, brittle nails.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Jaw pain:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin the patient history by asking the patient to describe the pain’s character, intensity, and frequency. When did he first notice the jaw pain? Where on the jaw does he feel pain? Does the pain radiate to other areas? Sharp or burning pain arises from the skin or subcutaneous tissues. Causalgia, an intense burning sensation, usually results from damage to the fifth cranial, or trigeminal, nerve. This type of superficial pain is easily localized, unlike dull, aching, boring, or throbbing pain, which originates in muscle, bone, or joints. Also ask about aggravating or alleviating factors.
Ask about recent trauma, surgery, or procedures, especially dental work. Ask about associated signs and symptoms, such as joint or chest pain, dyspnea, palpitations, fatigue, headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss. (Keep in mind that jaw pain may accompany more characteristic signs and symptoms of life-threatening disorders, such as chest pain in a patient with an MI.)
Focus your physical examination on the jaw. Inspect the painful area for redness, and palpate for edema or warmth. Facing the patient directly, look for facial asymmetry indicating swelling. Check the TMJs by placing your fingertips just anterior to the external auditory meatus and asking the patient to open and close, and to thrust out and retract his jaw. Note the presence of crepitus, an abnormal scraping or grinding sensation in the joint. (Clicks heard when the jaw is widely spread apart are normal.) How wide can the patient open his mouth? Less than 1 ⅛” (3 cm) or more than 2⅜” (6 cm) between upper and lower teeth is abnormal. Next, palpate the parotid area for pain and swelling, and inspect and palpate the oral cavity for lesions, elevation of the tongue, or masses.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Tetanus:
Diagnosis
(Handbook of Diseases)
Frequently, diagnosis must rest on clinical features and a history of trauma and no previous tetanus immunization. Blood cultures and tetanus antibody tests are often negative; only one-third of patients have a positive wound culture. Cerebrospinal fluid pressure may rise above normal. Diagnosis also must rule out meningitis, rabies, phenothiazine or strychnine toxicity, and other conditions that mimic tetanus.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Carpopedal spasm:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Ask the patient about the onset and duration of the spasms and the degree of pain they produce. Assess him for related signs and symptoms of hypocalcemia, such as numbness and tingling of the hands and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Determine whether the patient’s history includes previous neck surgery, calcium or magnesium deficiency, tetanus exposure, or hypoparathyroidism.
Ask the patient’s family members whether they noticed changes in his behavior. Mental confusion — even personality changes — may occur with hypocalcemia.
Physical examination
Inspect the patient’s skin and fingernails, noting dryness or scaling and ridged, brittle nails. Obtain his vital signs. Perform a head-to-toe assessment with a complete respiratory assessment. Check Chvostek’s sign (tapping of the facial nerve, which results in facial nerve spasm).
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Jaw pain:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Begin the patient history by asking the patient to describe the pain’s character, intensity, and frequency. When did he first notice the jaw pain? Where on the jaw does he feel pain? Does the pain radiate to other areas? Sharp or burning pain arises from the skin or subcutaneous tissues. Causalgia, an intense burning sensation, usually results from damage to the fifth cranial, or trigeminal, nerve. This type of superficial pain is easily localized, unlike dull, aching, boring, or throbbing pain, which originates in muscle, bone, or joints. Also ask about aggravating or alleviating factors.
Ask about recent trauma, surgery, or procedures, especially dental work. Ask about associated signs and symptoms, such as joint or chest pain, dyspnea, palpitations, fatigue, headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss. (Keep in mind that jaw pain may accompany more characteristic signs and symptoms of life-threatening disorders, such as chest pain in a patient with an MI.)
Physical examination
Focus your physical examination on the jaw. Inspect the painful area for redness, and palpate for edema or warmth. Facing the patient directly, look for facial asymmetry indicating swelling. Check the TMJs by placing your fingertips just anterior to the external auditory meatus and asking the patient to open and close, and to thrust out and retract his jaw. Note the presence of crepitus, an abnormal scraping or grinding sensation in the joint. (Clicks heard when the jaw is widely spread apart are normal.) How wide can the patient open his mouth ? Less than 1⅛" (3 cm) or more than 2⅜" (6 cm) between upper and lower teeth is abnormal. Next, palpate the parotid area for pain and swelling, and inspect and palpate the oral cavity for lesions, elevation of the tongue, or masses.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Carpopedal spasm:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient isn’t in distress, obtain a detailed history. Ask about the onset and duration of the spasms and the degree of pain they produce. Also ask about related signs and symptoms of hypocalcemia, such as numbness and tingling of the fingertips and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Check for previous neck surgery, calcium or magnesium deficiency, tetanus exposure, and hypoparathyroidism. Ask the patient if he had recent puncture wounds, and inquire about his immunizations.
During the history, form a general impression of the patient’s mental status and behavior. If possible, ask family members or friends if they have noticed changes in the patient’s behavior. Mental confusion or even personality changes may occur with hypocalcemia.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Jaw pain:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the patient history by asking the patient to describe the pain’s character, intensity, and frequency. When did he first notice the jaw pain? Did it arise suddenly or gradually? Where on the jaw does he feel pain? Does the pain radiate to other areas?
Sharp or burning pain arises from the skin or subcutaneous tissues. Causalgia, an intense burning sensation, usually results from damage to the fifth cranial, or trigeminal, nerve. This type of superficial pain is easily localized, unlike dull, aching, boring, or throbbing pain, which originates in muscle, bone, or joints.
Ask about recent trauma, surgery, or procedures, especially dental work. Ask about associated signs and symptoms, such as joint or chest pain, dyspnea, palpitations, fatigue, headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss. Also ask about aggravating or alleviating factors.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Carpopedal spasm:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in distress, obtain a detailed history. Ask about the onset and duration of the spasms and ask for a description of pain they produce. Also ask about related signs and symptoms of hypocalcemia, such as numbness and tingling of the fingertips and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Check for previous neck surgery, calcium or magnesium deficiency, tetanus exposure, and hypoparathyroidism.
During the history, form a general impression of the patient's mental status and behavior. If possible, ask family members or friends if they've noticed changes in the patient's behavior. Mental confusion or even personality changes may occur with hypocalcemia.
Inspect the patient's skin and fingernails, noting dryness or scaling and ridged, brittle nails.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Jaw pain:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin the patient history by asking him to describe the pain's character, intensity, and frequency. When did he first notice the jaw pain? Where on the jaw does he feel pain? Does the pain radiate to other areas? Sharp or burning pain arises from the skin or subcutaneous tissues. Causalgia, an intense burning sensation, usually results from damage to the fifth cranial, or trigeminal, nerve. This type of superficial pain is easily localized, unlike dull, aching, boring, or throbbing pain, which originates in muscle, bone, or joints. Also ask about aggravating or alleviating factors.
Ask about recent trauma, surgery, or procedures, especially dental work. Ask about associated signs and symptoms, such as joint or chest pain, dyspnea, palpitations, fatigue, a headache, malaise, anorexia, weight loss, intermittent claudication, diplopia, and hearing loss. (Keep in mind that jaw pain may accompany more characteristic signs and symptoms of life-threatening disorders such as chest pain in a patient with an MI.)
Focus your physical examination on the jaw. Inspect the painful area for redness, and palpate for edema or warmth. Facing the patient directly, look for facial asymmetry indicating swelling. Check the TMJs by placing your fingertips just anterior to the external auditory meatus and asking the patient to open and close, and to thrust out and retract his jaw. Note the presence of crepitus, an abnormal scraping or grinding sensation in the joint. (Clicks heard when the jaw is widely spread apart are normal.) How wide can the patient open his mouth? Less than 1 1⁄89 (3 cm) or more than 23⁄89 (6 cm) between the upper and lower teeth is abnormal. Next, palpate the parotid area for pain and swelling, and inspect and palpate the oral cavity for lesions, elevation of the tongue, or masses.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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