pain seminar. periodontics

GOOD morning

INTRODUCTION

CONTENTS DEFINITION HISTORY OF PAIN SIGNIFICANCE OF PAIN PAIN RECEPTORS PAIN PERCEPTION PAIN TRANSMISSION

PAIN FIBRES PAIN PATHWAYS PAIN CENTRES IN THE BRAIN

TYPES OF PAIN THEORIES OF PAIN METHODS TO CONTROL PAIN

LOCAL ANESTHESIA PAIN KILLERS (NSAIDS, OPIOIDS) ACUPUNCTURE

FUTURE TRENDS IN PAIN CONTROL

ELECTRONIC DENTAL ANESTHESIA, WAND CONCLUSION

DEFINITION

History of pain

The Babylonian concept Chinese Homer The Bible- anguish Hebrews- grief and sorrow Plato- soul Hippocrates- humors

Significance

SHORT LATENCY

LONG LATENCY

PAIN RECEPTORS

SOMATIC NOCIRECEPTORS

VISCERAL NOCICEPTORS

PAIN PERCEPTION

SUBSTANCES RELEASED SUBSTANCE-P SERATONIN HISTAMIINE BRADYKININ-prostaglandins to act

PAIN TRANSMISSION

PAIN FIBRES PAIN PATHWAYS

1.First order neurons

2.Second order neurons

3.Third order neuronsPAIN CENTRES

PAIN TRANSMISSION

PAIN FIBRES

A-delta fibres (immediate pain)

C fibres (diffuse pain)

PAIN PATHWAYS

Trigeminal nerve

Semilunar ganglion (g.g)

Pons

Sensory root

Ascending fibres Descending fibres

Tactile sensibility Pain and Temperature

Sensory root

PAIN PATHWAYS

Each end organ has its pathway into CNS

The pain pathway consists of

First order neurons

Second order neurons

Third order neurons

First order neurons

Cells of posterior nerve root ganglia

A- delta fibres- marginal cells in

posterior gray horn

C- fibres- Substantia gelatinosa in

posterior gray horn

Second order neurons

The marginal cells and the cells of Substantia gelatinosa form the second order neurons

Third order neurons

Neurons of Thalamic nucleus, reticular

formation, tectum and grey matter

around aqueduct of sylvius

These neuron axons reach sensory area

of cerebral cortex

Classification

Based on duration

Acute and chronic

Based on etiology

Inflammatory, Nociceptive and

Neuropathic pain

Atypical facial pain

Refered pain

Types of DENTAL pain Arising from

Pulp

Peri radicular region

Exposed dentin

Cracked tooth syndrome

Classification of Oro facial pain Physical Conditions

a. Somatic pain Superficial Somatic pain Cutaneous pain Mucogingival pain Deep Somatic pain Musculoskeletal pain TM Joint pain Periodontal Pain Osseous and periosteal pain

b. Visceral pain○ Pulpal dental pain○ Vascular pain○ Neurovascular pain

c. Neuropathic pain○ Episodic pain○ Continuous

THEORIES TO EXPLAIN PAIN SPECIFICITY THEORY

Descartes-1644 Muller-19th century Von frey-1895

PATTERN THEORY Gold Scheider-1894

GATE CONTROL THEORY

GATE CONTROL THEORY

GATE input

GATE output

Factors that OPEN the gate

Physical (injury)

Emotional (depression)

Behavioural (focusing on pain)

Factors that CLOSE the gate

Physical (medication)

Emotional (happiness, relaxation)

Behavioural (distraction)

Limitations

No one has located gate mechanism

Assumption of organic basis

Integration and interaction of mind and

body

DIAGNOSIS

Location Onset of the pain Duration Behaviour

Pain assessment tools

Visual Analog scale Mc Gill Questionnaire Numeric Pain Intensity Scale Simple Descriptive Pain Intensity Scale Graphic Rating Scale Verbal Rating scale Pain Faces Scale MPI Scale

Visual analog scale(VAS)

MANAGEMENT OF PAIN

LOCAL ANESTHETICS ANALGESICS NSAIDS OPOIDS CONSCIOUS SEDATION

ACUPUNCTURE

From Latin – acus=needle and pungere=prick

Acupuncture points

FUTURE TRENDS IN PAIN CONTROL

ELECTRONIC DENTAL ANESTHESIA

AUDIO ANALGESIA

WAND

ELECTRONIC DENTAL ANESTHESIA

In 46 AD, Scribonius Largus to emperor Claudius used torpedo fish to relieve pain

In 1883 Erb wrote “electric current is one of the brilliant remedies for neuralgic pain”

MECHANISM OF ACTION

ELECTRONIC DENTAL ANESTHESIA

Indications

Contra indications

Advantages

Disadvantages

AUDIO ANALGESIA

Described by Gardner and Licklider (1959)

This method uses loud sounds to produce insensitivity to pain in some patients.

WAND

CONCLUSION

REFERENCES Carranza, Newman, Takei, Klokkevold:

Carranza’s clinical periodontology, 10th Ed. Elsevier. Monheims –local anesthesia and pain control in

dental practice, 7th Ed, Pg 7 & 21, CBS Bell’s- Textbook of Orofacial pain Guyton- Textbook of medical Physiology, 10th Ed.

pg 553. Saunders Indu khurana- Textbook of Human Physiology Malamed- Handbook of Local Anesthesia, 5th Ed.

Pg 352-4, Mosby Shafers- Textbook of Oral Pathology

THANK YOU…