pain seminar. periodontics
DESCRIPTION
regarding the pain perception and by which mechanism. theories regarding painTRANSCRIPT
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…