ORE Part 1 Pain Management

Question 1

What is the definition of 'nociceptive pain' versus 'neuropathic pain'?

Accepted Answer

Nociceptive: pain arising from tissue damage activating nociceptors (normal protective function); Neuropathic: pain arising from damage or dysfunction of the somatosensory nervous system itself

Answer

They are synonymous — both describe tooth pain

Answer

Nociceptive pain is always acute; neuropathic pain is always chronic

Answer

Neuropathic pain only affects the trigeminal nerve

Question 2

What are A-delta and C fibres in the context of dental pain?

Accepted Answer

A-delta fibres: myelinated, fast-conducting (sharp, well-localised pain); C fibres: unmyelinated, slow-conducting (dull, burning, poorly localised, thermal pain) — both transmit nociceptive signals in dental pulp

Answer

A-delta and C are both types of motor nerve fibres

Answer

C fibres only carry proprioception from the PDL

Answer

A-delta fibres carry light touch only

Question 3

What is 'referred pain' in dentistry and give an example?

Accepted Answer

Pain perceived at a location distant from the actual source — e.g., mandibular molar pain referred to the ear, or maxillary sinus pain felt in upper posterior teeth

Answer

Pain that involves two adjacent teeth simultaneously

Answer

Pain that travels along the nerve after injection

Answer

Pain that is intermittent rather than continuous

Question 4

What is 'hyperalgesia' in the context of acute pulpitis?

Accepted Answer

Increased sensitivity to painful stimuli — in pulpitis, inflammation sensitises C fibres lowering their threshold, causing disproportionate pain responses to normally painful stimuli

Answer

Reduced pain sensitivity caused by inflammation

Answer

Normal pain response to dental caries

Answer

A type of referred pain

Question 5

What is the WHO analgesic ladder and how does it apply to dental pain?

Accepted Answer

A 3-step escalating framework: Step 1 = non-opioids (paracetamol, NSAIDs); Step 2 = mild opioids (codeine); Step 3 = strong opioids (morphine) — applied to dental pain starting at the appropriate step

Answer

A classification of dental pain only

Answer

Only applicable to cancer pain

Answer

A prescribing protocol for antibiotic use

Question 6

What is 'balanced analgesia' (multimodal analgesia) in dental pain management?

Accepted Answer

Using different analgesic classes with different mechanisms simultaneously (e.g., paracetamol + ibuprofen) to achieve better pain control with lower doses of each, reducing side effects

Answer

Using only the strongest analgesic available

Answer

Alternating opioids and non-opioids

Answer

Taking all analgesics at exactly the same time only