Systemic considerations for orofacial neuropathy

Abstract

Patients with orofacial neuropathic pain typically present with symptoms first hand to their general dental practitioner. It is important dental practitioners recognise the clinical presentations of these conditions for prompt diagnosis and appropriate management. This review will focus on the systemic causes of orofacial neuropathy. Infectious and autoimmune diseases with orofacial neuropathic manifestations such as post-herpetic neuralgia, paroxysmal neuralgias, painful trigeminal sensory neuropathies, peripheral neuritis and oral dysaesthesia will be discussed. Specifically, the prevalence, pathophysiology, clinical presentations and management of these conditions will be reviewed. Post-herpetic neuralgiaPost-herpetic neuralgia (PHN) is a chronic neuropathic pain condition persisting 3 months or greater following reactivation of varicella zoster virus (3). This peripheral system neuropathy results from damage to nervous tissue secondary to a herpes zoster attack. It is the most common neuropathic pain resulting from infection (4).Post-herpetic neuralgia has the potential to cause longterm severe pain, contributing to marked psychosocial dysfunction in the form of impaired sleep, decreased appetite and diminished libido (3,5). The impact of this condition can be drastic enough to transform independent living to dependent care (5).