Pain Management in Dentistry: A Review and Update
Pain Management in Dentistry: A Review and Update
Pain management is complex under taking; unfortunately we are
just being to learn the rules of game. It is the patient’s body that does the
healing, not the doctor; the most that we can do is providing favorable
condition for healing. Patient must understand that it is they, not we
who determine final outcome of therapy.
First step in the treatment of any condition is accurate and complete
diagnosis, what is problem, structures involved and condition account
for it.
Classification of Pain
Etiopathogenic classification of pain
A) Pain due to local causes
a. Pathologic changes in teeth and jaws
b. TMJ and associated muscles of mastication
c. Nose and Para nasal diseases
d. Oral mucosal diseases
e. Lymph node diseases
f. Salivary gland disease
g. Diseases of blood vessels
B) Pain along nerve trunk and central pathways
a) Trigeminal neuralgia and glassophyrangial neuralgia
b) Migraine and other types of head aches
c) A typical facial palsy
C) Referred pain from other organs
a) Cervical spondalities
b) Angina pectoris
c) Orophyrangial diseases
d) Diseases of ENT
Principles of Pain Management
1) Pain therapy is begun with non-narcotic analogies for mild to
moderate pain. If these drugs are ineffective intermediate potency
opoids such as codeine or its derivatives are combined with them.
NSAIDs are effective in many symptoms of bone associated pain are
as cartico steroids they also decrease stiffness, selling and tenderness.
Opoids and NSAIDs induce rapid change in pain sensation.
2) Treatment of acute pain requires location, origin and cause of
pain. Management implies target short-term symptomatic relief; because
the goal is to modify pain impulses during the period of tissue
healing. NSAIDs can limit pain, swelling and erythema other agents
given are muscle relaxants.
3) For severe or chronic pain analgesics are given at regular interval
in adequate dose. Medication should never be prescribed as needed basis
because pain will not resolve abruptly, oral medication is preferred,
especially long acting, unless patients factor prohibit such.
4) Analgesics adjuvant such as tricyclic anti depressants are added
to the drug regime if neural environment is suspected. Other adjuncts
include anticonvulsants, antiarrthythmics, antihistamines, or phenothizines
these agents usually require several days.
Pain Control
One of the most important aspects of practice of dentistry is control
or elimination of pain.
Methods of pain control
1. Removing the cause:
2. Blocking the pathways of painful impulses:
3. Pharmacotherapy of pain:
Analgesic Agents
Types:- Non-narcotic analgesics.
Narcotic analgesics.
Adjuvant analgesics.
Topical:
1. Injectable local anesthetic (LA).
2. Anti-inflammatory agents.
3. Muscle relaxants.
4. Antidepressants. etc.
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