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Participants must answer at least 12 of 15 questions correctly (80%) to earn CE credit.

AGD - Self-Instruction Exercise No. 415 - Orofacial Pain
Development of mirror pain following trigeminal nerve injury: a case report and review of neuropathic mechanisms

Self-Instruction Exercise No. 415
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Exercise No. 415
Subject Code: 200
Orofacial Pain

The 15 questions for this exercise are based on the article Development of mirror pain following trigeminal nerve injury: a case report and review of neuropathic mechanisms on pages 27-32. This exercise was developed by Riki Gottlieb, DMD, MS, FAGD, in association with the General Dentistry Self-Instruction committee.

Reading the article and successfully completing this exercise will enable you to:

  • review the details of a clinical case describing unexplained jaw pain;
  • understand the physiology of neuropathic jaw pain; and
  • consider treatment options for neuropathic jaw pain.

Answers for this exercise must be received by December 31, 2018.

  1. Mirror pain is described as all of the following except one. Which is the exception?

    A. contralateral pain
    B. ipsilateral pain
    C. extraterritorial pain
    D. pain in an uninjured nerve

  2. The patient’s inferior alveolar nerve (IAN) injury was first assessed by the authors ___ months after implant placement.

    A. 5
    B. 10
    C. 15
    D. 20

  3. Pain from the right side of the patient’s jaw started __ weeks after implant placement.

    A. 2
    B. 3
    C. 4
    D. 5

  4. The patient experienced all the following pain symptoms after injury except one. Which is the exception?

    A. soreness
    B. electric sensation
    C. tingling
    D. burning

  5. Panoramic and CBCT studies demonstrated that the implant was located on the __________ cortex of the IAN canal.

    A. superior
    B. inferior
    C. anterior
    D. posterior

  6. Initial head and neck examination elicited pain in the area of the right __________.

    A. temporomandibular joint
    B. submandibular gland
    C. bony ridge over the implant
    D. medial pterygoid muscle

  7. In __________, mild pain stimuli invoke excessive pain response in the injured area.

    A. hyperalgesia
    B. hyperpathia
    C. allodynia
    D. allovera

  8. Pain in the uninjured left side of the mandible began ___ months after the initial consultation.

    A. 2
    B. 3
    C. 4
    D. 5

  9. Sunderland’s classification of nerve injuries consists of ___ types.

    A. 2
    B. 3
    C. 4
    D. 5

  10. Sunderland type 1 nerve injury involves only the endoneurial tissue. Sunderland type 2 injuries result from forceful crush or traction injuries.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  11. Nerve injuries may induce __________ of synapse-like structures from intact neurons into adjacent regions of injured and necrotic central zones.

    A. dwindling
    B. splinting
    C. sprouting
    D. rooting

  12. Extraterritorial pain should be considered when there is no clear indication of inflammatory odontogenic pathosis. Testing for nerve responses to various stimuli should be performed with the patient’s eyes open and does not require special equipment or devices.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  13. All of the following are recommended medications for ongoing neuropathic pain after acute nerve injury except one. Which is the exception?

    A. Percocet
    B. Zoloft
    C. Neurontin
    D. Lyrica

  14. What percentage of patients with trigeminal posttraumatic pain experience pain relief after early reparative surgeries?

    A. 30
    B. 40
    C. 50
    D. 60

  15. The ideal time for surgical repair of an injured nerve is within the first ___ months following injury.

    A. 2
    B. 3
    C. 4
    D. 5


Evaluation

Please respond to the statements below, using the following scale:
1 Poor; 2 Below average; 3 Average; 4 Above average; 5 Excellent

Practicality of the content 1 2 3 4 5
Benefit to your clinical practice 1 2 3 4 5
Quality of illustrations 1 2 3 4 5
Clarity of objectives 1 2 3 4 5
Clarity of exercise questions 1 2 3 4 5
Relevance of exercise questions 1 2 3 4 5
 
Did this exercise achieve its objectives? Yes No
Did this article present new information? Yes No
How much time did it take you to complete this exercise? mins


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