100+ Free ABOP Orofacial Pain Practice Questions

Headache Disorders

ICHD-3 classification — migraine (with/without aura, chronic migraine ≥15 days/month with ≥8 migraine days), tension-type (episodic vs chronic), trigeminal autonomic cephalalgias (cluster, paroxysmal hemicrania — indomethacin-responsive, SUNCT/SUNA, hemicrania continua — indomethacin-responsive), medication-overuse headache (≥15 days/month with overuse of acute medication), secondary headaches and red flags (SNOOP10). PREEMPT Botox protocol for chronic migraine (155 U across 31 sites, 7 muscle groups, every 12 weeks). CGRP monoclonal antibodies — erenumab (receptor), fremanezumab/galcanezumab/eptinezumab (ligand). Gepants (ubrogepant, rimegepant acute; atogepant, rimegepant prevention). Triptans and cardiovascular contraindications.

TMD Diagnosis (DC/TMD 2014)

DC/TMD 2014 Axis I/II dual-axis framework. Axis I pain: myalgia, myofascial pain with referral, arthralgia, headache attributed to TMD. Axis I intra-articular: disc displacement with reduction (± intermittent locking), disc displacement without reduction (with/without limited opening), degenerative joint disease, subluxation. Clinical exam — palpation, range of motion (normal pain-free opening ≥40 mm), joint sounds (click vs crepitus). Imaging — panoramic screening, CBCT for osseous, MRI gold standard for disc position. Axis II psychosocial — Graded Chronic Pain Scale (GCPS), PHQ-9, GAD-7, JFLS, OBC, PCS. Wilkes staging I-V of internal derangement.

TMD Management

Stepped-care, conservative/reversible first. Patient education, self-care, jaw rest, soft diet, moist heat/cold, physical therapy, postural training. Occlusal splints — stabilization (flat-plane, full-arch, nighttime) preferred; anterior repositioning selective and time-limited. Pharmacotherapy — NSAIDs, short-term muscle relaxants (cyclobenzaprine), low-dose tricyclics (amitriptyline/nortriptyline for chronic myofascial pain), gabapentinoids. Arthrocentesis and arthroscopy for persistent intra-articular pathology. Open TMJ surgery (discectomy, disc repositioning, TMJ total joint replacement — Stryker/TMJ Concepts) for end-stage disease. Intra-articular injections (corticosteroid, HA, PRP). Behavioral — CBT, biofeedback, relaxation, graded motor imagery.

Neuropathic Orofacial Pain

Classical trigeminal neuralgia — ICHD-3 criteria, paroxysmal electric-shock pain in V2/V3 most common, trigger zones, neurovascular compression (superior cerebellar artery most common). Secondary TN — MS, cerebellopontine angle tumor (imaging required in atypical features). Painful trigeminal neuropathy — post-traumatic (peripheral nerve injury, post-endodontic), post-herpetic (VZV V1 most common), idiopathic. Glossopharyngeal neuralgia. Burning mouth syndrome — primary (idiopathic) vs secondary (nutritional — B12/folate/iron/zinc, candidiasis, xerostomia, medications). Carbamazepine first-line for TN (monitor CBC, Na, hepatic; HLA-B*1502 Asian populations); oxcarbazepine second-line; baclofen and lamotrigine add-on. MVD (Jannetta procedure), gamma knife, percutaneous glycerol/balloon/RF rhizotomy.

Pain Neuroscience

Nociception (A-delta fast/sharp vs C-fiber slow/burning) vs pain experience. Peripheral sensitization (inflammatory soup — bradykinin, prostaglandins, substance P, CGRP). Central sensitization — NMDA receptor, wind-up, LTP. Descending modulation — PAG, RVM, locus coeruleus; serotonergic and noradrenergic pathways (rationale for TCAs/SNRIs in chronic pain). Gate control theory (Melzack & Wall). Trigeminal nucleus caudalis (subnucleus caudalis, medullary dorsal horn) — convergence with C2-C3 afferents explains trigeminocervical referral. OPPERA prospective cohort — identified pain amplification, psychological distress, and clinical orofacial factors as risk for first-onset TMD.

Sleep & Bruxism

ICSD-3 sleep disorders. Obstructive sleep apnea — STOP-BANG screen, Epworth Sleepiness Scale, polysomnography AHI thresholds (mild 5-14, moderate 15-29, severe ≥30). CPAP gold standard; mandibular advancement device (MAD) for mild-moderate OSA or CPAP-intolerant — titration, side effects (TMD discomfort, salivation, occlusal changes — posterior open bite over time). Sleep bruxism — rhythmic masticatory muscle activity (RMMA), PSG confirmation with audio; comorbidity with OSA, GERD, SSRIs. Awake bruxism — ecological momentary assessment (EMA). Insomnia, circadian rhythm disorders, periodic limb movement, restless legs.

Pain Assessment

Multidimensional pain assessment. VAS/NRS 0-10, Faces Pain Scale-Revised (FPS-R pediatric/cognitive). McGill Pain Questionnaire (sensory/affective/evaluative descriptors). Brief Pain Inventory (severity and interference). Graded Chronic Pain Scale (GCPS — severity grades 0-IV). PHQ-9 depression (cutoffs 5/10/15/20), GAD-7 anxiety. Pain Catastrophizing Scale (PCS). Jaw Functional Limitation Scale (JFLS-8/JFLS-20). Central Sensitization Inventory (CSI). Oral Behaviors Checklist (OBC). Quantitative sensory testing — thermal, mechanical, pressure pain thresholds.

Pharmacology

NSAIDs (non-selective vs COX-2 selective celecoxib; GI/renal/CV risk). Acetaminophen (hepatic ceiling 3-4 g/day). Opioid stewardship — tramadol, tapentadol; risks include dependence, hyperalgesia, respiratory depression; CDC MED guidance. Tricyclic antidepressants — amitriptyline, nortriptyline (low-dose 10-50 mg qhs for chronic orofacial pain). SNRIs — duloxetine, venlafaxine. Anticonvulsants — gabapentin, pregabalin (neuropathic), carbamazepine/oxcarbazepine (TN), lamotrigine, topiramate (migraine prevention, renal stones/paresthesia). Muscle relaxants — cyclobenzaprine, tizanidine, methocarbamol (short-term). Topicals — lidocaine, capsaicin, ketamine, clonazepam for BMS. Benzodiazepines short-term only.

Diagnostic Blocks

Local anesthetic pharmacology — lidocaine (amide, max 4.4 mg/kg plain, 7 mg/kg with epinephrine; 300 mg max plain adult), bupivacaine (longer duration, cardiotoxicity). Diagnostic/therapeutic blocks — infraorbital (V2 — cheek, upper lip), mental (V3 branch — lower lip, chin), inferior alveolar, auriculotemporal (TMJ and preauricular region), greater occipital (cervicogenic headache, occipital neuralgia), sphenopalatine ganglion (cluster headache adjunct), stellate ganglion (sympathetic-mediated pain). Trigger point injections. Intra-articular TMJ blocks. Interpretation — placebo response, false-positive, controlled comparative blocks.

Persistent Idiopathic Facial Pain

Persistent idiopathic facial pain (PIFP, formerly atypical facial pain) — ICHD-3 criteria: persistent facial or oral pain recurring daily >2 hours/day for >3 months, poorly localized, not following peripheral nerve distribution, normal examination and imaging. Persistent idiopathic dentoalveolar pain (PIDAP, atypical odontalgia) — dentoalveolar pain without identifiable pathology. Diagnosis of exclusion — thorough workup, imaging, rule out structural/neuropathic causes. Management — TCAs, SNRIs, topical lidocaine/capsaicin, CBT. Strongly avoid iatrogenic endodontics/extractions/surgery in absence of clear pathology.

Research & Evidence

Study designs — RCT (gold standard for interventions), cohort, case-control, cross-sectional, case series. Biostatistics — sensitivity, specificity, PPV, NPV, likelihood ratios, NNT/NNH, relative and absolute risk reduction. Evidence-based medicine hierarchy (systematic review/meta-analysis > RCT > cohort > case-control > case series > expert opinion). Critical appraisal tools (Cochrane RoB 2, GRADE). PRISMA reporting. IMMPACT recommendations for chronic pain trials. Placebo response in pain research.

Cervicogenic Pain

Cervicogenic headache — Sjaastad criteria, ICHD-3 secondary headache attributed to disorder of cervical spine. Anatomy — trigeminocervical complex, convergence of C1-C3 afferents with trigeminal nucleus caudalis. Clinical features — unilateral, non-throbbing, triggered by neck movement/sustained posture, reduced cervical range of motion, tender upper cervical facets. Diagnostic blocks — C2-C3 zygapophyseal joint, third occipital nerve, greater occipital nerve. Treatment — manual therapy, physical therapy, trigger point injection, radiofrequency neurotomy.

Psychosocial & Behavioral

Biopsychosocial model of pain. Pain catastrophizing, fear-avoidance (Vlaeyen model), kinesiophobia (TSK). Depression and anxiety comorbidity with chronic orofacial pain. Somatic symptom disorder (DSM-5). Central sensitivity syndromes overlap — fibromyalgia (ACR 2016), IBS, chronic fatigue syndrome, vulvodynia. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), motivational interviewing, pain self-management, sleep hygiene.