First consideration in pain control is eliminating cause of discomfort

The only common dental procedure that someone can guarantee having at my clinic without an appointment is an extraction. This is simply because it is classified as a sudden crisis requiring immediate action. One understands an emergency as an unforeseen situation that requires immediate action. In dentistry as in medicine, pain and infection are often emergencies in every sense of the word. Since these emergencies may develop from seemingly ordinary circumstances, the control of pain and infection will be discussed from the routine as well as from the emergency standpoint.

Pain of the emergency nature is more likely to occur in the dental practice as a result of infections, trauma, and temporomandibular (jaw) joint or occlusal (biting) disorders. Obviously, the first consideration in pain control is to eliminate the cause of discomfort and institute indicated local and systemic therapeutic measures. Analgesics (pain killers) are then employed to alleviate pain until the direct treatment has eliminated the cause.
Whenever the dentist considers prescribing an analgesic or anti-inflammatory, he recalls certain clinically significant factors about pain itself. One of the most important considerations here is the psychological aspects of pain.
Generally, patients take pain killers that they are accustomed to or are familiar with. In any event this class of drugs do not require a prescription. But a basic regard in selecting a pain killer for any particular case is to match the potency of the analgesic against the severity of the pain. In this respect, one must never lose sight of the fact that the psychological makeup of the patient is an extremely imporatnt factor in the selection of the proper analgesic.
Pain has two components: perception and reaction. Healthy individuals appear to have essentially the same capacity to perceive pain, but their reaction to what they may perceive may vary widely. Discomfort that may require no drug in one patient may require aspirin in another, and even codeine, meperidine, or morphine in others. Therefore for a dentist, having relative knowledge of his patient is of considerable value.
Predisposition towards a greater reaction to pain has been said to be associated with patients with one or more of the following characteristics: (1) emotional instability, (2) fatigue (3) youth (4) female sex and (5) fear and apprehension. It is well known that many individuals will obtain greater benefit from an analgesic if they expect it to be effective or if they have found it to be effective in the past. The clinician should assert his confidence that a particular agent will give prompt relief. The confidence the patient has in his dentist will then be conveyed to the drug.
Mild to moderate pain of dental origin can usually be controlled by aspirin (200 mg every four hours). A similar dose of Acetaminophen (Tylenol) or Ibuprofen should be equally effective. These drugs provide an additional antipyretic (eliminating fever) effect. Acetaminophen is particularly useful in cases of allergy to aspirin and where gastrointestinal bleeding problems contraindicate the use of aspirin.
Strong pain killers include Talwin, Pentacine HCL, Demerol and morphine sulfate. These drugs, however, all have adverse potentialities and side effects. One must therefore always consider whether or not taking a strong pain killer is worth it bearing in mind the side effects. So while no one obviously likes pain, special effort should be taken to avoid it by preventing tooth decay, etc. Sometimes taking a pain killer within 3 hours before visiting your dentist may mask the precise tooth causing the pain and thus complicating quick diagnosis.

Dr. BERTRAND R. STUART D.D.S
For answers to questions about topics in this column you may e-mail me at: bertrand_stuart@yahoo.com

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