Diferencijalna dijagnostika bolnih stanja sluznice usne šupljine

Orofacial pain is a common complaint and challenging diagnostic problem. Among numerous causes of orofacial pain, the most common are diseases of teeth and periodontium, followed by various diseases and lesions of the oral mucosa. Pain of the oral mucosa is an accompanying symptom of different mucosal lesions caused by local or systematic factors. This type of pain belongs to the category of superfitial somatic pain, termed mucogingival pain. However, the pain of oral mucosa may be present in the absence of pathological findings. This type of pain may be caused by lesion of the nervous system, and is termed neuropathic pain, or it may be result of psychogenic disturbances. Pain of the oral mucosa can be also reflected (refered pain) from other parts of the body. Given the multitude of possible causes of intraoral pain as a component of orofacial pain, the diagnostic process is complex and requires a multidisciplinary approach. A prerequisite for establishing an accurate diagnosis is thorough knowledge of a wide spectrum of diagnostic characteristics of orofacial pain which include the origin and type of pain (somatic, neurogenic and psychogenic), duration (acute or chronic) and mechanisms of pain onset (nociceptive, neuropathic, psychosomatic) and their differentiation. The emphasis in this article is on differential diagnosis of the most common painful conditions of oral mucosa in respect to their clinical features.Orofacijalna bol česta je i dijagnostički zahtjevna tegoba. Među brojnim uzrocima orofacijalne boli najčešći su bolesti zuba i parodonta, a po tom i različite bolesti sluznice usne šupljine. Bol sluznice usne šupljine prateći je simptom različitih oštećenja sluznice uzrokovanih lokalnim ili sustavnim čimbenicima. Bol oštećene sluznice spada u kategoriju somatske površinske boli i naziva se mukogingivna bol. Međutim, bol sluznice može biti prisutna i u odsutnosti patološkog nalaza. Tada je riječ o neuropatskoj boli koja je posljedica oštećenja dijela živčanog sustava ili je bol psihogenog podrijetla. Bol sluznice usne šupljine može biti i odražena (refleksna bol) iz drugih dijelova tijela. S obzirom na mnoštvo mogućih uzroka orofacijalne boli, dijagnostički je postupak složen i zahtijeva multidisciplinarni pristup. Preduvjet za postavljanje točne dijagnoze jest poznavanje širokog spektra dijagnostičkih karakteristika orofacijalne boli, koje uključuje podrijetlo i vrstu boli (somatska, neurogena i psihogena), trajanje (akutna i kronična) i mehanizme nastanka boli (nociceptorska, neuropatska, psihosomatska) te njihovo razlikovanje. U ovome radu prikazana su različita bolna stanja sluznice usne šupljine i njihove diferencijalnodijagnostički bitne karakteristike