Pain and infection
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. As a rule, I always attend to patients immediately when they are in pain. 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, he recalls certain clinically significant factors about pain itself. One of the most important considerations here is the psychological aspects of pain. So, a basic regard in selecting a painkiller 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 important 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. It should also be borne in mind that forty per cent of the perception of pain is psychological. Many patients do not experience a previous pain once they sit in the dental chair. Soldiers in war zones are known to ignore their own serious injuries while seeing their colleagues heads literally blown off by bombs.
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 (fever eliminating) effect. Acetaminophen is particularly useful in cases of allergy to aspirin, and where gastrointestinal bleeding problems contraindicate the use of aspirin.
Strong painkillers 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 painkiller 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.