CHAPTascxsdcxsdfcxdsfcaxsdfcsxsdcaxER 6.pdf

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1. Pain control in dentistry
Prepared by: WriaS. Rasheed

2. Objectives
•Introduction
•Procedural Pain
•Topical anesthetics
•Local anesthetics
•Preoperative administration of NSAIDS
•Post-procedural Pain management
•Non-pharmacological interventions

3. Introduction
•The management of pain in dentistry encompasses a
number of procedural issues, including the delivery of
anestheticand the management of postprocedural
pain, as well as pain diagnosis, management
strategies for orofacialconditions that cause pain in
the face and head

4. Procedural Pain
•Acute pain may be associated with dental
procedures such as anestheticinjection, restorative
treatment, periodontal procedures, implant
placement, andtooth extraction.

5. Control of Procedural pain :
A.avoid accidental trauma
B.Good suturing
C.proper injection technique including:
1.slow delivery of the drug
2.selection of the proper needle size
D.Topical anesthesia
E.Local anesthesia

6. Topical Anesthetics
•The best formulation for injection pain control is the
gel or paste topical anesthetic. These include
•lidocaineor benzocainein ointment form.
produce surface tissue numbness in approximately 3
minutes.
•Another topical, tetracaine, which is combined with
benzocaine as an anestheticspray, produces rapid
numbness within oneminute.

7. Local anesthetics
•The effectiveness of a local anestheticin 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 anestheticis lidocaine(also called
xylocaineor lignocaine) with a half-life of 1.5-2 hours

8. •Other local anestheticagents in current use
includearticaine(also called septocaineor
ubistesin),bupivacaine(a long-acting anesthetic),
andmepivacaine
•Also, most agents come in two forms: with and
withoutepinephrine(adrenaline) or other
vasoconstrictor that allow the agent to last longer
and also controls bleeding in the tissue during
procedures.

9. Preoperative administration of NSAIDS
•Giving lornoxicamoral 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 .

10. Post-procedural Pain management
•Analgesics
•the most commonly used drugs for relief of toothache or
pain
•NSAIDs ,Paracetamol(acetaminophen) ,
aspirin

11. Ibuprofen , naproxen , Aspirin
•Work by blocking the action of both COX -1 and COX-2
thus inhibiprostaglandin syntesis
Ibuprofenoccasionally causes xerostomia(dry mouth)
that may increase oral plaque anddental caries

12. •A number of drug/dose combinations were found to have
demonstrated over 50% reduction in postproceduralpain
including:
1.ibuprofen 400 mg,
2.diclofenac50 mg,
3.etoricoxib120 mg, (Longest half-life >8 hours)
4.codeine 60 mg plus paracetamol1000 mg,
5.celecoxib400 mg,
6.and naproxen 500 mg.

13. •In patients with GI or kidney problems, a Cox-2 inhibitor
such as Celebrexcan be prescribed to reduce potential
adverse effects.
•Moderate postproceduralpain may necessitate the
prescription of an opioiddrug or tramadol combined
with an acetaminophen or a NSAID.

14. 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