Pain control in Dentistry

anesthesia, sedation, premedication, electronic dental anesthesia, etc

1. PAIN CONTROL IN OPERATIVE DENTISTRY

2. INTRODUCTION D ental treatment is often perceived as a painful treatment by patients However with emphasis on prevention, minimal intervention and modern atraumatic treatment techniques, pain and trauma during restorative procedures have been controlled

3. METHODS TO CONTROL PAIN 1. Local anesthesia 2. Premedication- antianxiety or sedative drugs 3. Inhalation sedation 4. Hypnosis 5. Electronic dental anesthesia

4. LOCAL ANESTHETICS AMIDE ESTER LIDOCAINE PRILOCAINE BUPIVACAINE MEPIVACAINE COCAINE PROCAINE CHLOROPROCAINE TETRACAINE

5. Amide type of local anesthetics are more commonly used in operative dentistry as they produce less allergy or hypersensitivity reactions 1. 2% Lidocaine + epinephrine 1:50,000 2. 2% Lidocaine + epinephrine 1:1,00,000 3. 0.5% bupivacaine + epinephrine 1:2,00,000 LOCAL ANESTHESIA

6. Patient factors Before administering LA, certain patient factors assessed Systemic health Allergy Psychology Systemic health Dentist should enquire about health status of patient regarding CVS, CNS, liver, kidney, thyroid, etc e.g :- in hypertensive patients, LA without vasoconstrictor given as vasoconstrictor cause increase in BP and heart rate

7. Allergy C ontraindicated in patients allergic to LA May cause anaphylactic reactions Psychology To avoid tension and promote patient comfort Use of kind and gentle approach Avoiding harsh words like inject, hurt etc Keep syringe and needle away from patients view Constant reassurance during injection

8. INFILTRATION ANESTHESIA Consists of supraperiosteal injection where the anesthetic is deposited near nerve endings at the operating site Usually done on maxillary teeth Techniques of local anesthesia Infiltration anesthesia Regional block anesthesia

9. Topical anesthesia Before administering anesthesia, topical anesthestic like lidocaine or benzocaine is applied to reduce discomfort during needle penetration Regional block anesthesia Anesthetic solution is deposited near a nerve trunk at a distance from the operating site Usually done on mandibular posterior site

10. PRECAUTIONS DURING INJECTION 1. The patient should be kept in a supine or semi- supine position 2. The solution should be deposited slowly to minimize pain 3. Injection into the infected area should be avoided 4. Syringe should have aspirating feature ADVANTAGES OF LOCAL ANESTHESIA Patient relaxed and cooperate Controls salivation Reduced blood flow Operator efficiency

11. PREMEDICATION WITH ANTI-ANXIETY DRUGS OR SEDATIVES To calm the patient during dental treatment Agents used:- Diazepam 2-10 mg Alprazolam 0.25-0.5 mg Midazolam 2-5 mg 1 hour before dental treatment

12. INHALATION SEDATION Many patients with mild or moderate fear of dental treatment can benefit from conscious sedation with nitric oxide+oxygen Advantage – safe when compared to general anesthesia Disadvantage - costly

13. HYPNOSIS To control tense patient Through hypnosis patient can be made more relaxed and cooperative

14. ELECTRONIC DENTAL ANESTHESIA Works on the principle of Gate control theory of pain transmission Frequency >120 Hz Produces sensation that may be described as “vibrating”, “throbbing”, “pulsing” or “twitching”

15. MECHANISM OF ACTION 1. Acts by stimulating A- fibres (touch, pressure, temperature) This inhibits transmission of pain impulses produced by high speed drill which are transmitted by A-delta and C- fibres 2. Blood levels of serotonin and endorphins are increased which play secondary role in pain transmission

16. INDICATIONS Needle phobic patients Patient allergic to local anesthesia Pain control prior to LA especially for palatal injection CONTRAINDICATIONS Pts with cardiac pacemakers Epilepsy Very young and very old patients Pregnancy

17. ADVANTAGES No need for injections Anesthetic effect only for required time Residual analgesic affect last for several hours DISADVANTAGES High cost Learning curve Intraoral electrodes are weak in this system

18. CARE DURING OPERATIVE PROCEDURES Use of mouth mirrors for proper retraction Rubber dam- protection of soft tissues Avoid slow speed drill- time consuming heat generation vibration 4. Airotor with coolant 5. For deep caries- use of slow speed burs or spoon excavator to avoid pulp exposure Proper instrument grasps and rests Avoid dessication of cavity by blowing air through air-water syringe Gingival retraction cord- protect gingiva in subgingival preparation Pulp protective agents during restoration

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