Pain & Inflammation Control in Dentistry: Anesthesia, Analgesics & More
Pain & Inflammation Control in Dentistry
6.1 Categories
- Pain Control: Anesthesia and analgesia.
- Inflammation Control: Corticosteroids and NSAIDs.
- Infection Control: Antibiotics.
- Anxiety Control: Benzodiazepines.
- Mouthwashes: Topical application of substances via rinsing.
6.2 Local Anesthesia
Local anesthesia is a locoregional anesthesia that suppresses localized pain without affecting consciousness. Local anesthetics are injected near the target area.
A) Types of Local Anesthetics
- Esters (e.g., procaine): Effective but may cause allergic reactions.
- Amides (e.g., lidocaine, mepivacaine): Safer alternative.
B) Vasoconstrictors
Vasoconstrictors (e.g., adrenaline) prolong anesthetic effects by constricting blood vessels. Caution: Avoid using vasoconstrictors in patients with heart problems or high blood pressure, and avoid using them in the palate due to the risk of palatal necrosis.
C) Anesthesia Instruments
Anesthesia is administered using syringes and carpules. Carpules are glass cylinders containing the anesthetic. Disposable and non-disposable syringes are available.
- Non-disposable metal syringes: Consist of a body, restraint rings, and a plunger.
- Disposable plastic syringes: Only the piston is non-disposable.
Needles vary in length and gauge. Longer needles are used for the lower arch, and shorter needles are used for the upper arch.
D) Anesthesia Techniques
- Injection: Infiltration (numbing nerve endings) or nerve block (numbing an entire nerve).
- Topical: Spray or viscous mixture (provides superficial pain relief).
6.3 General and Sedation Anesthesia
General anesthesia is administered via inhalation or intravenously. It is used for difficult patients, those with disabilities, or lengthy procedures.
Conscious sedation uses nitrous oxide gas to induce a state of drowsiness without loss of consciousness.
6.4 Pain and Inflammation Control
Pain is a defense mechanism. It can be controlled at the central nervous system and nerve endings.
A) Opiate Analgesics
Opiates act on endorphin receptors to reduce pain. Common opiates include codeine and tramadol. Note: Opiates can cause tolerance and dependence.
B) NSAIDs
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) reduce pain and inflammation by suppressing prostaglandin synthesis. Common NSAIDs include diclofenac, ibuprofen, piroxicam, and ketoprofen. Caution: NSAIDs are contraindicated in patients with gastric issues.
Paracetamol: Relieves pain and fever but is not anti-inflammatory. Safe for patients with gastric problems.
Aspirin: Powerful analgesic and anti-inflammatory, but inhibits platelet aggregation and can increase bleeding risk. Avoid use before tooth extractions.
C) Corticosteroids
Corticosteroids (e.g., prednisone, triamcinolone) reduce inflammation and suppress the immune system. They are used for allergic reactions and autoimmune diseases. They can be administered locally using orobase.
6.5 Fighting Infections
Antibiotics are used to treat bacterial infections. Common antibiotics include:
- Amoxicillin (penicillin): Often combined with clavulanic acid.
- Macrolides (e.g., azithromycin): Used for patients allergic to penicillin.
- Metronidazole: Effective against anaerobic bacteria, often combined with spiramycin.
Antifungals (e.g., nystatin, fluconazole): Treat fungal infections like candidiasis.
Antivirals (e.g., acyclovir): Treat viral infections like herpes zoster.
6.6 Anxiety Control
Benzodiazepines (e.g., diazepam, bromazepam, clorazepate, lorazepam) are used to control anxiety and induce sleep.
6.7 Mouthwashes
Mouthwashes are categorized into three groups:
- Antiseptic: Contain chlorhexidine, hexetidine, or triclosan to treat oral infections.
- Antiplaque: Help remove bacterial plaque.
- Tissue Reinforcement: Contain fluoride, vitamins, or potassium nitrate to strengthen oral tissues.