What is orofacial pain?

Orofacial pain What is orofacial pain? Orofacial pain is a general medical term that is often used to describe pain that may be occurring in any part of the face including the jaws, scalp, mouth, and face. The pain may be caused by diseases or disorders of structures that make up the face and oral cavity. In some cases, the pain may be referred to the face area from the scalp or the ear. Today it is being recognized that in many cases, the most common source of orofacial pain is from the mouth. The second most common cause is related to the temporomandibular joint dysfunction (TMD). All the other causes of orofacial pain are rare. Orofacial pain disorders are quite challenging for the physician because pain can arise from many sources. Diagnosis and management of orofacial pain is now increasingly being managed by dentists, ear nose and throat specialists and sometimes even neurologists. What are causes of orofacial pain? There have been attempts to classify causes of orofacial pain but there is no one system that is universally accepted. The simplest way to classify causes of orofacial pain is as shown: Oral Cavity causes - Cracked tooth - Dental cavities - Dental abscess - Teeth hypersensitivity - Gingivitis - Burning mouth syndrome - Ulcers of the mouth - Cancer of the mouth Neuropathic pain Trigeminal neuralgia Glossopharyngeal neuralgia Mental nerve neuralgia Headache Cluster headache Migraine Temporomandibular joint dysfunction (TMD) Emotional causes Anxiety Depression Psychosomatic How common is orofacial pain? Orofacial pain is a very common problem in society. In the US alone, it is believed that nearly 1/5th of the adult population has had some type facial pain in the past 6 months. In the majority of cases, this pain is due to a dental problem like a toothache. Next most common cause of orofacial pain is temporomandibular pain, which is often chronic in nature. Orofacial pain can affect both genders and can occur at any age. How do patients with orofacial pain present? The majority of patients complain of pain near or inside the oral cavity. In some cases the pain is continuous and in others it may occur with facial movements like chewing, swallowing, biting or speaking. The pain is often a dull ache and may even occur at night. Orofacial pain is often unresponsive to the usual over the counter pain medications. How is orofacial pain diagnosed? The diagnosis of orofacial pain is not easy because there are many structures around the face and mouth that can cause pain. The majority of people go through many healthcare providers before a correct diagnosis is made. Eventually most people are referred to a dental surgeon or an ear nose throat specialist. Besides a through physical exam, one also needs to undergo series of X-rays, CT scans and even MRI. One may need to see a number of specialists to determine the cause of pain. How is orofacial pain managed? The treatment of orofacial pain depends on the cause. If there is problem with teeth or gums, this can be managed by the dentist. If the problem is TMD then the treatment will be geared towards restoring function of the jaw and limiting pain. What are Home care remedies for TMD? 1. Patient education –the more a patient knows about the disorder the better is the outcome. Once patients learn that the condition is not life threatening, anxiety and pain are relieved. 2. Resting the muscles used for chewing and eating is also necessary; thus one may have to eat a soft diet, and apply moist heat or ice therapy. 3. If there is nighty grinding of the teeth this should be addressed by the dentist and wearing a night guard can help. Physical therapy Physical therapy is very helpful in restoring function of the TMJ. By strengthening muscles of chewing, this can help decrease inflammation and improve range of motions. It is best to enroll in a physical therapy program for a few weeks Medications Various medications are used to treat orofacial pain depending on the cause. The most common medications include use of: - Pain medications - Injection of local anesthetics - Corticosteroids - Muscle relaxants - Botox injections - Use of antidepressants Other Therapies Some people with TMJ syndrome may also benefit from oral appliances and acupuncture. Surgical care is undertaken when medical therapy fails or is ineffective. Surgery is usually the last choice of treatment and should never be undertaken if one has not attempted physical therapy or pharmacological management first. Types of surgery to treat TMJ syndrome include injection of corticosteroids, aspiration or cleaning the joint. Prognosis In most cases of TMD, the prognosis is good. Recurrence of pain is rare after treatment. In all cases, the initial treatment is conservative. Home care remedies usually are tried out first, followed by medical care and then surgery, as the last option.

Vacation in Rawai, Phuket.

Way before Pattaya and Koh Samuii became famous, one of the best places to visit in Thailand was Phuket. Located on the southern tip of Thailand. Phuket was once home to celebs from all over the world because of is pristine blue waters, soft sandy beaches, tropical weather and warm waters of the Andaman sea- it is the closest thing to paradise- serene, beautiful and stunning sunsets. Phuket is the largest island in Thailand and is connected to the southern tip of Phang Nga Province by a narrow road bridge. However, another small island that is not far from the southern tip of phuket is Rawai. This hidden gem is only known to a few people chiefly because of its location. Unlike phuket, few people come here to Rawai but it has stunning scenery that rivals almost any place in Asia. Tourists come here to experience Thai culture, relax, enjoy the tropical weather and watch the costal palm trees gently swaying in the wind- it is place of serenity and solitude. Coming to Rawai is like going to one of the small islands in the Caribbean where there are no crowds and you have the island to yourself. To get to Rawai, one has to take a ferry or a boat from phuket. This sea front town is divided into two segments; the northern part with its partially developed beaches and the southern part, which is more urbanized and has a fishing port. Getting there To get to Rawai, one first needs to get to Phuket. Small boats and ferries make the 30 min trip and charge about $2. Most tourists first fly into Bangkok and take the 60 mi trip to phuket by the local airlines. One can take a train or the bus to phuket but it is a long trip. Getting around Rawai may be a small island but the terrain is uneven and everything is spread out. So one should try and rent a motorbike which costs about $5-$8 a day. The good thing about Rawai is that there is little motor traffic and hence you will be safe. What to do Rawai is a place where most people come to relax and get away from the crowds. Some people just take it easy, get a tan and enjoy the evening and morning walks along the beach. The one place you should visit is the Phuket Sea Shell museum. The museum is strictly focussed on the exotic shells from the Andaman Sea. There are many exotic varies of shells here and some are very elegant. Entrance to the museum is $8 for adults. Unlike other places in Thailand, Rawai’s beach areas are heavily congested with boats and other small sailboats. Thus, this is not the place where you can swim but you can have the entire sandy beach and get a gorgeous tan. The northern part of rawii beach does allow for swimming in some areas but the south does not. Most people rent a boat and visit the nearby islands to catch the stunning scenery, go snorkeling and scuba diving. If you have time then perhaps a visit to the nearby islands of Ko Kaeo or Kon Bon which are worth a visit; about 30 minutes away the under water scenery is breathtaking and the beaches are immaculate. Go to Sea Gypsy village where there are many restaurants, nightclubs and bars. The nightlife is sedate compared to Bangkok but the view of the scenery is good enough for national geographic. Finally no one should leave this island without having spent an evening on Promthep Cape View Point, which is world famous for its splendid sunsets. Food Like most places in Thailand, you will not go hungry on Rawai. There are many food vendors, cafeterias and beach side restaurants. Food is relatively cheap and delicious. You can have a decent meal for less than $5 almost anywhere on the island. Some people go fishing/diving and bring their catch to the street vendors who cook up a great meal in the evening. Accommodation There are hostels for the budget traveler that cost anywhere from $12-$15 a room. In addition, there are some excellent villas and seaside hotels which cost about $50-$60 a night. You are unlikely to experience such views of the water in many other places on this planet. Today, one of the best ways to get cheap and great accommodation is via airbnb. Most airbnb rentals are cheaper than any hotel and are located along the beach. Cost varies from $30-$40. Final Word Over the past few years, phuket has earned a bad reputation because of crime, extreme congestion with tourists and being expensive. Thus, if you are looking for somewhere more quiet, peaceful, relatively cheap and just as beautiful, try Rawai island. This small island is fast becoming a popular destination for many people because of the scenery and its beauty. Best time to visit is from Feb to June, when the weather is not too hot or humid

How did I get pubic lice? I am a clean 22 year old female.

Cleanliness has nothing to do with sexually acquired disorders. You may be clean and perfect, but your partner may be a bum. If you got pubic lice, then you most likely got it during a sexual encounter from someone who already had these creatures. What this means is that both of you need treatment otherwise you are going to be passing on these nasty creatures to your other potential sexual partners. Just a word of warning- in some states not telling a partner that you have a sexually transmitted disease and having sex can lead to a lot of legal hassles.

I have tiny black insects in my pubic hair and I am very itchy. Any idea what this is? I am a 22 year old male

Looks like you got crabs or pubic lice. These tiny creatures are intense black and can cause a fair amount of skin irritation. There are a number of ways to get rid of them. You will need to get an over the counter medication called Quellada, also sold as Derbac-M and Prioderm. This lotion will kill the lice with a single application. The medication must be thoroughly rubbed into the pubic area and left for a minimum of 6-12 hours- the longer the better. Apply it at night and rinse it off in the morning. Most people need another application in 7-10 days to ensure that all the adults as well as the eggs have been killed. Since this is a sexually acquired infestation, your partner must also be treated

Does Viagra protect against sexually transmitted diseases?

Absolutely not. 

All men who buy Viagra should understand that the pill does not protect against any sexually transmitted diseases like HIV, gonorrhea or HIV. Thus, safe sex practice using latex condoms should be practiced.

How long does a genital herpes infection last?

Almost all genital blisters turn into open ulcers after a few days. The soreness does diminish a little but the general ill health continues for 5-14 days. 


After about 7-10 days, the ulcers dry up, become crusted and fall off. The entire episode can last 7-12 days. After the initial infection, the virus disappears and goes into a latent stage and may never again cause an infection (if you are lucky).


However, mind you the herpes virus never ever leaves the body and hides inside nerves. When the right opportunity presents, it again reactivates- albeit the pain is a little less this time.

I think I may have acquired genital herpes. Will the lesions become painful?

No one ever forgets an acute genital herpetic outbreak. 


The sores are tender to touch and even urination is painful. In those who are liberal in their sex life and acquire an anal infection, the feeling is like a hot-burning needle around the rectal area- in fact quite painful and pooping is almost impossible. 


Any thoughts of eroticism and sexual intercourse are always absent because of the pain.


For men, blisters occur at the tip of the penis and cause difficulty with urination and even wearing tight undergarments can be very uncomfortable. Of course, men have the same degree of pain as women.

How soon do herpes lesions appear after sex?

Herpes simplex has a fairly standard presentation. Those who become symptomatic from the infection never forget the episode and dread the beast. 


The symptoms usually arise 2-3 days after acquiring the infection following sexual activity. 


Most individuals will have an odd feeling, burning, tingling, pain or an odd ache in the genital area. A few days later, painful blisters will become prominent around the penis or vagina. The number of blisters is variable but most individuals develop at least a couple. The pain is sharp and burning in nature. 


Many an individual has required admission to the hospital for pain control from a herpetic genital infection. 

I am a 22 year old male and think I have contracted herpes. Where will the symptoms appear?

In men, herpetic lesions are most common near the tip of the penis. A few individuals do develop the blisters on the shaft of the penis. 


In those who engage in anal intercourse, the blisters can occur around the entire anus. Lesions around the buttocks and back of the thigh are also common.


In women, the lesions are most common on the inside of the labia and cervix. However, the lesions may occur anywhere on the inside or outside of the vagina.

Can I transmit herpes even if I have no symptoms?

You sure can.


Despite what everyone thinks, not all herpes infections are associated with symptoms. A significant number of individuals have no symptoms at all and never even know they have a herpetic infection. 


Despite the fact these individuals have no signs or symptoms of an infection; they all have the capability of transmitting the infection to their partners. Most people who acquire genital herpes get it from a partner who has no symptoms. 


It is doubtful if anyone sane would have any type of a sexual activity with a partner in the presence of full-blown herpes infection. In fact, in the presence of an active infection, the affected individual will not have the desire to have sex with anyone. 

Is there a test to detect herpes?

There are tests available for herpes, but sometimes they turn up negative. When there is an obvious discharge or an open sore, a sample of the fluid can be looked under an electron microscope. The test does require extensive preparation of the sample to be looked at under the microscope. In many cases, the test does end up as a negative. Checking for a virus under a microscope is not routine practice.

There is a blood test whereby one can check for antibodies to the virus. When the herpes virus infection is acute, the body’s immune system will react by making antibodies which react towards the virus. These antibodies can be checked in blood.

The blood test is most sensitive when there is an active infection present. When the herpes infection disappears, the antibody levels fall off and are sometimes not measurable. If the blood tests reveals the presence of antibodies, than it means you may have either oral or genital herpes. If the is negative, it simply means that you may have the virus, but the levels of antibody are too small to be detected. In other words you do not have an acute infection at the moment.

How do i know if i have herpes?

Herpes simplex is very common in the North American population. You may have herpes but not have any symptoms. The virus generally hides in nerves and flares up periodically. Not everyone who acquires herpes has symptoms. In fact the majority of people who do have herpes (and you could be one of them) have no idea if they have the virus.

Herpes virus (type 1) is easily contracted from kissing an affected individual or having sex. Some individuals may deny having sex but there are not many people who have not been kissed! So chances are that you may not have genital herpes if you have not had sex, but more than likely you may have oral herpes.

Oral herpes is extremely common and simple contact of sores with hands or the mouth can easily transfer the virus to the unsuspecting individual. Estimates from infectious disease data indicate that close to 60-80 percent of adults in North America have oral herpes.

Genital or type 2 herpes is slightly less common but there are still a lot of adults who have this virus. The virus is easily acquired during sex and estimates indicate that close to 20-30 percent of the population has this virus.

The majority of individuals who have herpes do not even know they have it. And if you do not know, you play a role in the spread of the virus. Eventually the virus will cause symptoms and then you will definitely know if you have herpes.

Surgical methods to remove venereal warts

The initial treatment of venereal warts is usually medical. However, sometimes the wart may be bleeding or may be too large and surgery is another option of treating venereal warts. Surgery is also an ideal method for pregnant females if do not want to have the baby exposed to venereal warts. Today, there are several decent surgical options for removing venereal warts. These options include the following:

Cryotherapy (liquid nitrogen). In this method, liquid nitrogen is applied with a Q-tip on the wart. The initial treatment is not painful but as the wart starts to breakdown, the skin does become sensitive. The skin will blister and the wart will slowly slough off. One goes to a skin clinic where the physician applied liquid nitrogen 1-2 times a week. One needs long-term treatment which usually averages anywhere from 8-16 weeks. While the treatment is effective, it does tend to hurt in the later stages.

Electrocautery- this is just another fancy name for a heated electrical current to be applied to the wart. It is definitely painful. The treatment is effective but most people cannot tolerate the pain. The physician may apply a cooling gel o r a local anesthetic, but electrical current is still painful. It usually feels like a hot needle which is plunged into your skin (teach you not to fool around without a condom next time)

Surgery: Sometimes the wart may just be hanging off a stalk and can easily be excised. Most of these small warts can be removed with the use of local anesthesia. However, some warts located near the vagina or anus can be difficult to remove with only local anesthesia- the pain can be significant.

Laser: Today lasers are used of everything except cooking food. The laser generates an intense beam of light that generates energy. The laser can cut as well as kill the wart cells. Large warts requires multiple sessions. While laser is good, it hurts like hell and is very expensive. It is usually not the first method of choice. Most physicians reserve the laser for large warts that have failed other treatments.

Once a wart has been treated, there is no guarantee that it will not come back. All these treatments do not actually kill the virus, just the wart cells.

Aldara to Treat Venereal Warts part 2

Aldara cream should not be used by individuals who have allergies to any of the components in the cream.

During the time, Aldara is applied, sexual activity of all type is not recommended, and this means no oral, anal, or vaginal sex. For a female, great care should be exercised when the cream is applied near the vagina. It should not be applied anywhere on the inside of the vagina otherwise considerable pain and swelling can occur.

Males who are uncircumcised and have warts under the foreskin should retract the foreskin and clean the area on a daily basis

Aldara is not a cure for genital warts and new warts can occur after and during therapy

Because aldara may weaken condoms and vaginal diaphragms, it is recommended that these devices be used as a method of birth control. Because the effects of Aldara on the fetus are unknown, pregnant females and those who are breast feeding should avoid using the drug.

Aldara is only recommended for individuals over the age of 12

Aldara is not a cheap drug. It is not covered Medicare or any medical insurance plan. A 12 pack costs anywhere from $125-$175.

For those who do not have that kind of money, perhaps liquid nitrogen (cryotherapy) may be an alternative- cheap but a wee bit painful especially if the wart is large.

Aldara to Treat Venereal Warts

Aldara is the brand name for imiquimod, which is an immunomodulator type of drug. It is available as a 5% cream and used to treat a variety of skin conditions including venereal warts. For some unknown reason, it only works on genital warts and not the common warts.

For venereal warts, the area should first be cleaned and dried. The surrounding skin should be protected by some Vaseline or moisturizing cream. Aldara cream can be applied on the wart with a Q-tip. The cream is best applied at night and allowed to remain for 6-10 hours. In the morning, the area should be thoroughly rinsed. Almost all individual do develop some type of skin reaction that varies from moderate to severe.

The skin may show an intense redness, weeping or peeling after the first few applications. In some individuals, aldara may also cause general fatigue, fever, nausea and muscle pain. For those who develop serious skin flare ups, use of aldara should be discounted.

After application of aldara cream, one should avoid the sun because of the increased sunburn sensitivity. Suntan should be avoided until the skin has completely healed and aldara has been discontinued.

The cream is usually applied 3 times a week (e.g., Monday, Wednesday, and Friday) and most individuals begin to see a clearing of the warts in 8-12 weeks.

Treatment of warts with podophyllotoxin

Many physicians use the substance podophyllotoxin to treat venereal warts. Podophyllin is actually a plant substance extracted from the plant podophyllum peltatum. For decades, it has been used as a medicinal compound by the North American Native Indians.

Podophyllotoxin actually prevents the wart cells from multiplying and dividing. Eventually all the wart cells die and the wart disappear.
Today Podophyllin is available only with a prescription and used as a cream or solution. It is not recommended to be used internally or for warts that are larger than a quarter.

In most cases, physicians apply the Podophyllin themselves and are reluctant to give out a prescription because the chemical is toxic. Once the skin is washed and completely dry, one should apply a cream on the normal skin. This is to prevent the Podophyllin from irritating normal skin. Then using a Q-tip the Podophyllin is applied and the wart is covered. The wart must be dry before applying the chemical. Podophyllin is applied twice a day for 3-4 consecutive days. In most cases, the treatment has to be repeated for several weeks.

In general, Podophyllin should not be applied for more than 5 weeks. Within this time period, most warts are gone. It is extremely important to make sure that the Podophyllin does not come into contact with the eyes, nose, mouth or healthy skin, inside the vagina, rectum or the urethra. If this happens, flush with water for 15-20 minutes. If inadvertent contact has been made with healthy skin, apply Vaseline or zinc ointment. Wash hands after each application and discard the Q-tip.

The first application of Podophyllin on the wart is painless but the subsequent applications do sting. This is because the wart is dying and the raw surface is exposed. Itching, pain and redness are common complaints. These effects are transient and can be reduced by applying some over the counter hydrocortisone.

Women who are pregnant or breast-feeding should not be treated with Podophyllin, as the safety of this agent has not been demonstrated on the fetus.

Podophyllin is a great drug for warts as long as one can tolerate the subsequent pain and discomfort.

Treatment of warts with trichloroacetic acid

The first thing that everyone who has warts needs to understand is that more than 1/3rd of all cases of genital warts disappear spontaneously without doing anything. For the majority of individuals who have warts that are not bothersome, the best thing to do is Nothing- and that means keep away from health care professionals.

For individuals who have warts which are causing symptoms like burning, itching, bleeding or pain, then one can seek treatment. The majority of other individuals who seek treatment have no symptoms but are bothered by appearance of warts on the genitals. The second thing that all people who have warts should know is that the HPV is never completely destroyed with treatment. The virus has an ability to hide and genital warts can recur after treatment.

The treatment options are as follows:

Trichloroacetic acid (TCA) or bichloroacetic acid can be used to treat venereal warts. The acid works by destroying the top protein layer on the warts and slowly reduces growth. Trichloroacetic acid is only supposed to be applied once a week. To prevent skin irritation, it has to be applied only on the wart.

The health care professional will apply some Vaseline or a thick cream around the normal skin before applying the TCA to the warts.

TCA works about 60%-80% of the time and the effects are not immediate. In most cases, warts take anywhere from 6-10 weeks to disappear. TCA is most effective for the very small warts (< 3 mm).

When TCA is initially applied on the wart, it does sting for a few minutes. Individuals who have sensitive skin should be forewarned, TCA can cause moderate pain, severe irritation and blister formation it if gets on normal skin. Individuals who have large warts > 5 mm, should not apply TCA. TCA can be quite painful when more of it is applied to skin.

Because of the potential for complications, TCA applications for warts is only performed by health care professionals. Home use of high strength TCA is not recommended.

Diagnosis of Venereal Warts

When the warts are large, they are easy to diagnose. Sometimes, however, warts can be small and may be mistaken for a skin tag or scar. Some physicians do apply acetic acid (vinegar like solution) to the genitals. This immediately whitens the warts and one can view the warty like structure under a microscope. It is extremely rare for a wart to be cut out for diagnosis.

For women, when a wart is identified, several other tests are also important. Because Warts are associated with the human Papilloma virus and known to cause cervical cancer, women need a pap test.

The Pap test is a fancy word for taking scrapings (swabs) from the cervix and looking at them underneath a microscope. Pap tests are generally recommended for all women within 3 years after having started sex or at the age of 21-whichever comes first. After the age of 30, pap tests are infrequent if one has had all previous tests which were normal.

Women who have venereal warts need to have a pap tests every 3-6 months depending on the severity of changes in the cervix.

Can you get herpes from a toilet or a public washroom?

Well, anything is possible but it is very unlikely. The majority of viruses do not survive outside the body for more than a few seconds. In damp moist environments, bacteria may grow but viruses generally perish. All sexually transmitted disorders like herpes, gonorrhea, Chlamydia etc are transmitted via sexual intercourse; break in the skin or coming in contact with infected fluids like blood.

So as long as you are not having unprotected sex or drinking blood from an infected individual in the bathroom, you should be okay.

Even if an individual with active herpes uses a bathroom or the toilet, it is very unlikely that the virus will come out of the body system and remain viable on inanimate objects. In any case, always wash your hands, practice good hygiene, use a condom when having sex with an unknown partners, and play safe

Sex is Fun until one gets Gonorrhea Part 9

Follow-up

It is essential that the entire course of antibiotics be completed. Once the antibiotic course has been finished, it is important that the individual be retested to make sure that the infection has been treated. A major part of treatment for gonorrhea involves treatment of the partner. All sexual partners must be notified and tested for infection to ensure that the infection is not re-transmitted in a cycle. With a wide acceptance of an open sexual life style with multiple partners, it is highly recommended that the individual also get tested for other sexually transmitted disease like Chlamydia, syphilis and human immunodeficiency virus (HIV).

Prevention

Prevention of gonorrhea

- Use of latex condoms during sexual intercourse
- Avoidance of sexual intercourse with high risk partners
- Get partners tested for STDs prior to any sexual activity.

Outlook

After the antibiotic treatment is completed, more than 95-99% of first time episodes of gonorrhea are cured. A few individuals may not respond and may require alternative drugs.

Consultations

In cases of suspected rape or child abuse, it is mandatory to discuss the case with other specialists such as social workers, psychiatrists and pediatricians. It is important to obtain and stores the samples in the presence of some legal authority. Every detail about the case must be documented and all physical findings must be recorded/photographed for possible medico-legal reasons. All physicians are required to report the case to child protective services if there is any hint of abuse.