seadtion and pain control in dentistry

8/8/2019 Seadtion and Pain Control in Dentistry

http://slidepdf.com/reader/full/seadtion-and-pain-control-in-dentistry 1/63

Sedation and Pain Control in

Dentistry

Iyad Abou Rabii

DDS. OMFS. DU. MRes. PhD



Welcome

BienvenueWillkommen

Benvenuto

Bienvenida

yôkoso

tervetuloa

welkom



Please mute Your cell!



Are we doing our best to help

our patients to

get red of their pain?

Are we doing our best to help

our patients to

get red of their pain?

Can we do more?Can we do more?



DATE DurationSlides

49 1 hour

Let us try to answer this

16/11/2010



Yes or No

The Dentist is the best judge of pain.

A person with pain will always have obvious signs such as moaning,

abnormal vital signs, or not eating.

Addiction is common when opioid medications are prescribed.

Morphine and other strong pain relievers should be reserved for the late

stages of dying.

Morphine and other opioids can easily cause lethal respiratorydepression.

Pain medication should be given only after the resident develops pain.



minhr



secmin



Yes or No

The Dentist is the best judge of pain.

A person with pain will always have obvious signs such

as moaning, abnormal vital signs, or not eating.

Addiction is common when opioid medications are

prescribed.

Morphine and other strong pain relievers should be

reserved for the late stages of dying.

Morphine and other opioids can easily cause lethal

respiratory depression.

Pain medication should be given only after the resident

develops pain.

No

No

No

No

No

No



Sarah has presented at your office

reporting severe pain that kept her

awake all night. She denies any

contraindications to NSAIDs. Aft er examinat ion, you f ind t he

pat ient is suff ering f rom

irreversible pulpi t is wi t h acut e

apical periodont i t is, and a root

canal procedure is ini t iat ed.

This pat ient may will experience

some post-appoint ment pain due

t o cont inued inf lammat ion of t he

periapical t issues.



NO apparent factors for

odontogenic pain,

No consistent relief of pain by

local anesthetic.

Bilateral pain or multiple painful

teeth.

Pain that occurs with a

headache.

Increased pain associated withpalpation of trigger point or

muscles, emotional stress,

physical exercise, head

position, etc.

Presence of etiologic factors

for an odontogenic origin, (e.g.

Caries, leakage of

restorations, trauma, fracture).

Responsive to dental

treatment

Pain reduction by local

anesthetic.

Unilateral and localized pain. Sensitivity to temperature.,

percussion , and digital

pressure.

Pain in dental clinic

Non-odontogenicOdontogenic



During

InterventionPreoperative

Pain

Post-Operative

Pain Control Strategy



Pain

PreoperativeDuring

Intervention

Post-Operative

Pain Control Strategy



Pre-operative

Oral Sedation

Preoperative Analgesics

SCENEPain Control Strategy



During the Intervention

IV Sedation

Nitrous Oxide

Local Anesthesia

SCENEPain Control Strategy



Post-opertaive

Analgesic Prescription

Opioids

Non-opioids

SCENE



Pre-operative procedures



Page

28

Oral Sedation

Happy pills

Before the appointment,



Page

29

Oral Sedation : Drugs Used

Anti-Anxiety Pills (Benzodiazepines or "Benzos")

"Sleeping pills" (Barbiturates)

Antihistamines



Page

30

Preoperative Analgesics

Pre-treating patients with NSAID's

delays the onset of post-operative

pain and reduces its magnitude

when it does occur.

Pretreatment withacetaminophen is not effective.

Aspirin in not used for this

purpose since it can increase

bleeding.



During Surgical or Dental

Intervention



Page

32

IV Sedation

Anti-anxiety variety, is administered into the blood system during dental

treatment

Safe

The drugs which are usually used for IV sedation are not painkillers



Page

33

IV Sedation : Drugs Used

± benzos

± Barbiturates(sleep-inducing drugs)

± Opioids

± Propofol



Page

34

IV Sedation : Caution and Contraindication

± contraindications include pregnancy, known allergy to benzos, alcohol

intoxication, CNS depression, and some instances of glaucoma.

± Cautions include psychosis, impaired lung or kidney or liver function, and

advanced age. Heart disease is generally not a contraindication



Page

35

Nitrous Oxide

Referred to as laughing gas or

sweet air

Useful for fearful patients as well as

young children

After the patient is relaxed and

sedated, the dentist can

comfortably give the injection or

proceed to dental treatment



Page

36

Nitrous Oxide: Contraindications

± Some chronic obstructive pulmonary diseases

± Severe emotional disturbances or drug-related dependencies

± First trimester of pregnancy

± Treatment with bleomycin sulfate



Page

37

Local Anesthesia



Page

38

Local Anesthesia : Choice of Drug and Technique

1-According to procedure (expected duration, the surgical procedure

tissue¶s implication)

2- According to the patient physiological and pathological situation



Page

39

Failure of Anesthesia

Pathological causes

Psychological causes

Anatomical causes

Operator dependent



Page

40

Failure of anesthesia

Psychological causes of failure

Pathological causes of failure of anesthesia

± Factors precluding access

± Inflammation



Page

41


Anatomical causes of failure of anesthesia

± Soft-tissue analgesia is more easily obtained, needing a lower degree of

penetration of solution into nerve bundles, than does analgesia from pulpal

stimulation.

± A numb lip does not indicate pulpal anaesthesia.

± Accessory nerve supply

± Barriers to anaesthetic diffusion

± Dense compact bone can prevent a properly given infiltration from working.

Counter by using intraligamentary or regional LA.



Page

42

Accessory nerve supplies



Page

43


Operator dependent causes of failure of Anesthesia

± Choice of LA

± Poor technique

inadequate volume of LA.

Injection into a muscle (will result in trismus which resolves spontaneously).

Injection into an infected area (which should not be done anyway as this

risks spreading the infection).

Intravascular injection; clearly of no analgesic benefit. Small amounts of

intravascular LA cause few problems.



Page

44

Management of failure of Anesthesia

A technique suggested for patients who have experienced local anesthetic

failure in the mandible is

Intraligamentary injection of 0.2ml lignocaine with adrenaline per root.

Buccal and lingual infiltrations adjacent to the tooth of interest using around 1.0ml of lignocaine and adrenaline

Repeat inferior alveolar and lingual block injection using 3% prilocaine with0.03IU/ml felypressin

Conventional inferior alveolar and lingual block with lignocaine and adrenaline(1.5ml), followed by long buccal nerve block with remainder of cartridge.



Page

46

Management of failure of Anesthesia

A technique suggested for patients who have experienced local anesthetic

failure in the maxilla is

Intraligamentary injection of 0.2ml lignocaine withadrenaline per root.

Nerve bloc : posterior superior, infraorbital

Buccal and palatal infiltration

Buccal infiltration



Page

47

Failure management : Maxilla



Page

48

Important general points

Nerve trunks Thickness

In nerve trunks autonomic functions are blocked first, then sensitivity to

temperature, followed by pain, touch, pressure, and motor function.

Soft tissue anesthesia is reached before the levels needed for pulpal

anesthesia, which takes several minutes and will wear off first



Post-operative procedures



Page

50

Analgesic Prescription

Ceiling effect

± The term ceiling effect has two distinct meanings, referring to the level at

which an independent variable no longer has an effect on a dependent variable

± In case of Analgesics, a ceiling effect in treatment, is pain relief by some kinds

of Analgesics drugs, which have no further effect on pain above a particular

dosage level



Page

51

Types of Analgesics

± Opioid

Morphine

Tramadol

± Non-opioids

acidic analgesics ± Salicylic acid derivat ives

± Acet ic acid derivat ives

± Propionic acid derivat ives

± Ant hranilic acid derivat ives

non-acidic analgesics

± Aniline derivat ives

± Pyrazolone derivat ives



P

age

53

Types of Analgesics



Non-odontogenic Pain



Trigeminal Neuralgia

± Non-analgesic drug (Carbamazepine) give excellent results in

the treatment of Trigeminal Neuralgia

± Dose

100 mg twice daily

No improvement: the dose is increased to 200 mg four time a

day

No improvement : Dose can be augmented until 1600 mg a day

with (monitoring of plasmatic concentration of the drug should be

achieved regularly)

± If with such dose there is no improvement then Phenytoin

is used (150 to 300 mg daily)



TMJ Pain

Diazepam has both sedative and muscle relaxant effects, so it is helpful if the origin of the trismus is psychotic

In other cases the use of P

aracetamol 250 mg in combination withChlorzoxzson (muscle relaxant ) 300 mg is recommended 4 times daily.



atypical facial pain

The use of Tricyclic antidepressant looks helpful (Amitriptyline)

Anyway the prescription of such drugs should not be done by a dentist



1

2

3

Long acting local anesthetics

Precise estimation of the pain

Use the right analgesic

Conclusion

6

5

4

Profound local Anesthesia

Removal of the cause

Accurate Diagnostic



Pain management schema



What about Sarah ?



Thank you for

your attention!

Any Questions?



Contact Details

Dr. Iyad Abou Rabii

+33612198442

+966532758000www.facebook.com/iarabii

www.Twitter.com/iarabii

www.Scribd.com/iyad abou rabii

Email

[email protected]

[email protected]

seadtion and pain control in dentistry

Documents