Drugs for pain management in dentistry

Abstract

Pain is one of the most common reasons patients seek dental treatment. It may be due to many different diseases/conditions or it may occur after treatment. Dentists must be able to diagnose the source of pain and have strategies for its management. The '3-D's' principle -diagnosis, dental treatment and drugs -should be used to manage pain. The first, and most important, step is to diagnose the condition causing the pain and identify what caused that condition. Appropriate dental treatment should then be undertaken to remove the cause of the condition as this usually provides rapid resolution of the symptoms. Drugs should only be used as an adjunct to the dental treatment. Most painful problems that require analgesics will be due to inflammation. Pain management drugs include non-narcotic analgesics (e.g., non-steroidal anti-inflammatory drugs, paracetamol, etc) or opioids (i.e., narcotics). Nonsteroidal anti-inflammatory drugs (NSAIDs) provide excellent pain relief due to their anti-inflammatory and analgesic action. The most common NSAIDs are aspirin and ibuprofen. Paracetamol gives very effective analgesia but has little anti-inflammatory action. The opioids are powerful analgesics but have significant side effects and therefore they should be reserved for severe pain only. The most commonlyused opioid is codeine, usually in combination with paracetamol. Corticosteroids can also be used for managing inflammation but their use in dentistry is limited to a few very specific situations.Key words: Dentistry, pain, analgesics, non-steroidal antiinflammatory drugs, NSAIDs.Abbreviations and acronyms: ACTH = adrenocorticotrophic hormone; CNS = central nervous system; NSAIDs = non-steroidal anti-inflammatory drugs.Aust Dent J 2005;50 Suppl 2:S14-S22

Drugs Prescribed by Dentists in Fars Province, Iran

“…Although the effects of corticosteroids, such as reducing post-treatment pain and swelling, is well known, they should be used with care and be administered locally whenever possible, due to their side effects they cause (18)(19)(20). Studying the patterns of drug prescription of dentists in New York, the rate of drug injection was only 1.5%.…”

Analgesics Use in Dentistry

“…Nonopioid analgesics are available as "over-the-counter" medications and in U.S.A, 16 millions of these drugs are prescribed annually. There are fewer indications for opioids compared to nonopioid analgesics due to their side effects profile; these should be used with caution only in case of severe pain [21].…”

“…This selection in dental practice is not always simple due to numerous confounding factors related to the mechanism and clinical manifestation of pain [21].…”

Akılcı ilaç kullanımı ilkeleri doğrultusunda diş hekimliğinde kişisel analjezik listesi oluşturulması

“…Antiinflamatuar etkisi yok denecek kadar azdır (19,22,25). Yarılanma ömrü 2-3 saat olan parasetamol 4-6 saat arayla 325-1000 mg (maksimum 4000 mg/gün, erişkin) şeklinde reçete edilebilir (Tablo 4), (18,22,25).…”

“…Ayrıca GİS'te sekresyonları ve peristaltik hareketleri inhibe etmesi, mide bulantısını ve kusmayı tetiklemesi, öksürük merkezini baskılaması, miyozis yapması iyi bilinen karşıt etkilerindendir (1, [16][17][18][19][20]22).…”