Pain control in dentistry

Prepared by: Wria S. Rasheed

Objectives•Introduction•Procedural Pain•Topical anesthetics •Local anesthetics•Preoperative administration of NSAIDS

•Post-procedural Pain management•Non-pharmacological interventions

Introduction• The management of pain in dentistry encompasses a

number of procedural issues, including the delivery of anesthetic and the management of postprocedural pain, as well as pain diagnosis, management strategies for orofacial conditions that cause pain in the face and head

Procedural Pain

• Acute pain may be associated with dental procedures such as anesthetic injection, restorative treatment, periodontal procedures, implant placement, and tooth extraction.

Control of Procedural pain :

A. avoid accidental traumaB.Good suturing C.proper injection technique including:

1. slow delivery of the drug

2. selection of the proper needle size

D.Topical anesthesiaE.Local anesthesia

Topical Anesthetics• The best formulation for injection pain control is the

gel or paste topical anesthetic. These include

•lidocaine or benzocaine in ointment form.

produce surface tissue numbness in approximately 3 minutes. 

• Another topical, tetracaine, which is combined with benzocaine as an anesthetic spray, produces rapid numbness within one minute.

Local anesthetics

• The effectiveness of a local anesthetic in controlling procedural pain depends on factors such as:

• the precision of the injection

• bone density at the site of the injection

• nerve anatomy,

 

• The most commonly used local anesthetic is lidocaine  (also called xylocaine or lignocaine) with a half-life of 1.5-2 hours

• Other local anesthetic agents in current use include articaine (also called septocaine or ubistesin), bupivacaine (a long-acting anesthetic), and mepivacaine

• Also, most agents come in two forms: with and without epinephrine(adrenaline) or other vasoconstrictor that allow the agent to last longer and also controls bleeding in the tissue during procedures. 

Preoperative administration of NSAIDS

• Giving lornoxicam oral medication prior to nerve block, significantly improved the efficacy of the procedure in comparison to placebo, suggesting that pre-administration of this NSAID may be useful in establishing good anesthesia in patients with irreversible pulpitis .

Post-procedural Pain management

• Analgesics

• the most commonly used drugs for relief of toothache or pain

•NSAIDs , Paracetamol(acetaminophen) , aspirin

Ibuprofen , naproxen , Aspirin

• Work by blocking the action of both COX -1 and COX-2 thus inhibi prostaglandin syntesis

 Ibuprofen occasionally causes xerostomia (dry mouth) that may increase oral plaque and dental caries

• A number of drug/dose combinations were found to have demonstrated over 50% reduction in postprocedural pain including:

1. ibuprofen 400 mg, 2.diclofenac 50 mg, 3.etoricoxib 120 mg, (Longest half-life >8 hours)4.codeine 60 mg plus paracetamol 1000 mg, 5.celecoxib 400 mg, 6.and naproxen 500 mg.

• In patients with GI or kidney problems, a Cox-2 inhibitor such as Celebrex can be prescribed to reduce potential adverse effects.

• Moderate postprocedural pain may necessitate the prescription of an opioid drug or tramadol combined with an acetaminophen or a NSAID.

Non-pharmacological interventions

• Rinse your mouth with warm water.• If the toothache is caused by surgery, apply a

cold compress to the outside of your cheek.• Avoid eating/drinking very hot or cold foods,

try to eat food that’s not very hard.• Avoid negative pressure