1
Q
what are the 5 traditional methods of pain control
A
- removal of cause
- psychosomatic methods
- use of a drug to block the pathway of the painful stimulus
- raise the pain threshold
- depression of the CNS
2
Q
how can we as hygienists help remove the cause of pain
A
- temporary pain: blade angulation
- continuous pain: further investigation needed!
3
Q
what are psychosomatic methods of pain control
A
- verbal instructions, suggestions, hypnosis, relaxation techniques, distraction will lessen patient’s pain reaction, but not pain alone (pain perception)
4
Q
what can we as hygienists do with drugs for pain control
A
- topical and local anesthetic used to block the impulse before it is carried to the CNS
- this interferes with pain perception which lessens or eliminates pain
5
Q
how can we raise a patient’s pain threshold
A
- by using drugs that provide “conscious” sedation
- ie. nitrous oxide, narcotics, barbiturates, psychosedatives
- can be used alone or in combination
6
Q
how can we depress the CNS for pain control
A
- general anesthetic agents depress the entire central nervous system -> causes total elimination of reaction to pain
7
Q
how do we achieve topical anesthetic
A
- direct application of anesthetic agent onto mucous membranes
- agent is absorbed by free nerve endings creating anesthetic effect
- topical is easily absorbed by blood vessels in the area
8
Q
which is more likely to have a toxic reaction, topical or local, and why
A
- more likely to occur with topical
- why: higher concentrations than local and when applied in vascularized areas (floor of the mouth) rapid absorption occurs
- DO NOT APPLY TOPICAL ON LINGUAL SURFACES OF MAND OR FLOOR OF THE MOUTH
9
Q
what are the 3 different forms of topical anesthetic and when do we recommend using each
A
- gels: recommended prior to local anesthetic or during scaling
- liquids: recommended during scaling
- sprays: discouraged to use due to difficulty to control. pt and clinician may inhale the agent
10
Q
what is the most common complication involving topical and why
A
- tissue irritation due to high concentration
11
Q
what are the 2 uses of topical anesthetics
A
- preinjection
2. during a scaling procedure
12
Q
what is the process of applying topical for preinjection
A
- dry area
- apply small amount of topical with cotton-tipped applicator for 1-2 minutes in specific area
- dry or rinse away
- pressure anesthesia or schema is produced by applying pressure with cotton-tipped applicator prior to palatal injections to minimize pain
13
Q
what is the process of applying topical during a scaling procedure
A
- most effective way to get localized topical anesthesia in gingival sulcus is with topical (ie. oraquix)
- carry liquid topical to the bottom of a dried sulcus with a curette or applicator for recommended time, then rinse
- if you find the need to use in most sulci then use local anesthesia to decrease risk of toxic reaction
14
Q
why do we use local anesthetic
A
- chemical agents that produce short and completely reversible loss of sensation in specific area
15
Q
what are the 9 desirable properties of local anesthetics
A
- sterile agents
- stable in solution but bio transformed in body
- non-irritating to the tissues
- will not cause permanent damage to the nerve
- low systemic toxicity
- low potential for producing allergic reactions
- adequate potency without use of harmful concentrations
- rapid onset of anesthesia
- long duration enough to permit completion of procedure
16
Q
when should we use local anesthetic (6 points)
A
- if patient exhibits low pain threshold
- extensive treatments (high degree in quadrants/sextants)
- root planing or soft tissue curettage
- localized areas of extensive perio involvement
- abundant bleeding making visibility difficult (use of vasoconstrictor)
- any procedure that will produce pain
17
Q
what is important to know before using local anesthetic on a patient
A
- thorough knowledge of patient’s medical history
- thorough knowledge of possible complications
- thorough knowledge of anesthetic agent and vasoconstrictors
- contraindications, ie liver dysfunction = no AMIDE or uncontrolled hyperthyroidism = NO vasoconstrictors
- knowledge of drug interactions (multiple medications)
18
Q
when can we use nitrous oxide
A
- may be used for restorative, deep sub gingival scaling, root planing, soft tissue curettage
- health history is essential
- recognition of need for nitrous prior to local anesthetic
- for patients with low pain threshold and very anxious
- been used for more than 100 years in dentistry
19
Q
how does nitrous oxide work and what must we do when patients are using nitrous oxide
A
- affects CNS by depressing the cerebral cortex, thalamus, hypothalamus, and reticular activation system
- nervous impulses no longer being relayed to cortex or interpreted differently
- patient must NOT lose consciousness during sedation
- monitor vitals continuously
20
Q
what are the benefits if nitrous oxide
A
- comforts and relaxes the patient by altering pain reaction
- increases pain threshold
- alters patient’s perception of time (goes faster)
- more efficient appointment
- rapid elimination -> no driver needed
21
Q
what is TENS
A
- TENS = transcutaneous electrical nerve stimulation
- used in sports medicine to decrease pain cycle by increasing blood levels of serotonin and endorphins, results in increased pain threshold
- TENS used dentally to relieve chronic pain of TMJ and myofascial pain dysfunction
22
Q
what is electronic dental anesthesia
A
- EDA founded in 1970’s (dental version of TENS)
- EDA used for acute pain created during dental procedures
- uses higher frequency than TENS
- not used a lot because it is expensive and uncomfortable
23
Q
how do we use hypnosis in dentistry
A
- has been used as an adjunct to N2O especially in apprehensive children
- affects the subconscious mind to receive suggestions and recall those at a later time
- additional training required
- patient must be open minded about hypnosis to be a good candidate
- patients will not do anything they would not normally agree to do
24
Q
how can hypnosis be used as an adjunct to local and nitrous oxide
A
- hypnosis alone will not eliminate pain
- acts as a sedative
- treatment time is also altered in patient’s mind
- children are very receptive to hypnosis as they have open minds
25
what is biofeedback for pain control
- includes psychological techniques such as relaxation techniques and psychotherapy for pain control
- clinicians require further training
- has been known to successfully deprogram patients from bruxing and clenching
26
what is acupuncture used for in pain control and what are some benefits
- useful for sedation (relaxation), TMJ (ease of opening), increasing post op healing
- benefits include lack of side effects, minimal change in treatment time, sedation without the need for a driver
- additional training required, NB has no regulatory body for acupuncture
- additional armamentarium - points, alcohol swabs
- suitable for anyone except where bleeding or excessive movement is possible (but can also use acupressure)
27
what is acupressure -- EFT tapping
- physiologically, EFT has been found to normalize brain waves, relax to trapezius, and reduce salivary cortisol levels
- preliminary research has shown it to be promising for dental anxiety
28
what is computer controlled local anesthetic delivery
- regulates the rate of flow of solution (motor and microprocessor)
- more comfortable for the patient and operator
29
what is used to reverse local anesthesia and why is it used
- phentolamine mesylate (alpha adrengeric receptor antagonist) reverses effects in 30 minutes
- risk of self injury from anesthesia in soft tissues post-op (biting cheek and not feeling it)
30
what is buffered local anesthetic
- LA is acidic compared to tissues
- pain during injection, slow onset of action, lack of effect in inflamed/infected tissues
- sodium bicarbonate buffered solution raises pH to solve these problems
31
what is nasal local anesthetic mist
- single use intranasal spray (6 mg tetracaine HCl, 0.1 mg oxymetazoline HCl)
- tetracaine diffuses through tissues easily
- plural anesthesia of teeth 1-5 in affected quad, and soft tissues
32
what are some longer acting agents for post-surgical pain management
- neurotoxins from sealife, such as
- tetrotoxin
- saxitoxin
- neosaxitoxin
- nanoparticles and liposome microparticles
- magnesium
33
how do light-activated and inactivated local anesthetics work
- optogenetics: light controls neural activity of cells
Pain Management
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