1. Dental Pain, Diagnosis and Clinical Management of Dental Pain Part I
SLO
• 1.Define dental pain and orofacial pain disorders.
• 2.Discuss type and causes of dental pain.
• 3.Explain the mechanism and taking into consideration the risk factors of dental pain.
Dental pain and orofacial pain
▪Definition - Pain is a general term that describes uncomfortable sensations in the body. It stems from activation of the nervous
system. Pain can range from annoying to debilitating. It may feel like a sharp stab or dull ache. It may also be described as
throbbing, pinching, stinging, burning, or sore.
Acute dental pain
• ▪location
• ▪type
• ▪frequency and duration
• ▪onset
• ▪exacerbation and remission (for example the response to heat or cold)
• ▪Severity (score system)
Short, Sharp, Shooting pain
• either generalised or confined to one region of the mouth.
• Pain may be due to fluid movement through open tubules in the dentine or there may be some initial inflammatory
changes in the dental pulp.
• It can be caused by caries, dentine exposure on root surfaces, split cusp, lost or fractured restoration or a fractured
tooth.
• ▪associated with hot, cold or sweet stimuli.
• Pain is only present when a stimulus is applied. In the case of a cracked cusp, grainy bread or hard food may create a
sharp pain, maybe brief, on biting or chewing.
• Gingival recession, recent scaling, or tooth wear may cause generalized dentine sensitivity. But with caries, fractured
fillings and cracked cusps, the pain tends to be localized to the affected tooth.
• Intermittent sharp, shooting pains are also symptomatic of trigeminal neuralgia, so care must be taken not to
mistakenly label toothache as neuralgia.
• Treatment for sharp, shooting pain
− Desensitising toothpaste and a reduction in acid in the diet, use of a fluoride mouth-rinse, in the case of caries, a lost
filling or fractured tooth, coverage of the exposed dentine with a temporary restoration.
2. 1. Give right diagnosis
2. Give right tx based on dx
▪Appropriate treatment reduces the inflammatory process that underlies most acute dental pain emergencies.
1. 1.This may include restorations
2. 2.Nonsurgical root canal treatment.
3. 3.Reducing the occlusion
4. 4.Performing a pulpotomy on vital cases
5. 5.Incision for drainage
▪Dental treatments able to reduce inflammation, leading to lowered tissue levels of inflammatory mediators.
3. Give right drugs
Local anesthetics are an important drug class in treating emergency pain patients.
• ▪Analgesics are another commonly used drug class for treating odontogenic pain patients. NSAIDs are often
considered a drug of choice in treating.
• Multiple randomized, placebo-controlled clinical studies have shown that NSAIDs such as ibuprofen, in doses ranging
from 400-600 mg, provide profound analgesia for inflammatory pain.
• 800 mg ibuprofen reduced palpation pain by 40%, percussion pain by 25% and cold pain by 25% on teeth with a
diagnosis of symptomatic irreversible pulpitis and symptomatic apical periodontits.
Antibiotics are another drug class often used for treating emergency pain patients with odontogenic infections.
• Instead, analgesics may be co-prescribed with antibiotics when treating pain patients with odontogenic infections.
• It should be noted that antibiotics should only be prescribed to patients with systemic signs of infection (e.g., fever,
swelling, malaise or compromised airway). Patients with cellulitis or those who are medically compromised may also
require antibiotic therapy.
