Nederlands tijdschrift voor tandheelkunde
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Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either be located in a healthy tooth or in the temporomandibular joint. ⋯ In 2 cases trigeminal neuralgia is successfully managed with a neurosurgical microvascular decompression procedure according to Jannetta. Characteristic pain attacks resembling neuralgic pain result from well understood pathophysiological mechanisms. Consequently, adequate therapy, such as a Janetta procedure and specific pharmacological therapy, is available.
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In accordance with current views on pain, a distinction is made, on a physiological basis, among 'normal', or nociceptive pain, inflammatory pain and neuropathic pain. 'Normal', nociceptive pain is a reaction to possible or actual tissue damage. Inflammatory pain is a response to actual tissue damage, in which not only nociception occurs but the sensitivity of nocisensors changes through morphological transformation. This phenomenon is called sensitization and lies at the root of multiple types of chronic pain. Sensitization also plays an important role in neuropathic pain as a result of damage to the neuronal structures themselves.