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Prevention and Optimal Management of Peri-Surgical Pain in Dentistry

From Volume 45, Issue 10, November 2018 | Pages 935-946

Authors

Tara Renton

BDS, MDSc, PhD

Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London

Articles by Tara Renton

Abstract

It is every patient's right to expect optimal pain management in relation to routine elective surgery. Dentistry is a profession predicated upon causing and/or managing pain in patients. Poorly managed pain, or severe pain, peri-operatively, is the predominant cause of complaints in NHS dentistry, often leading to legal or GDC scrutiny. Whether the unexpected or persistent pain initiates the patient's suspicions about possible sub-optimal treatment, which then precipitates a complaint, is a possible hypothesis. For now, however, focusing on managing the patient holistically using up-to-date pain management should be a priority for all dental teams. Recent evidence highlights the risks of opiate and opioid dependence and mortality. In addition, the minimal benefit these medications provide for peri-operative pain management compared with other over-the-counter (OTC) analgesics is recognized. Competent patient management, optimal local anaesthetic techniques and intelligent prescription of non-steroidal anti-inflammatories and paracetamol are the mainstay for odontogenic and surgical pain management.

CPD/Clinical Relevance: It is imperative that dental teams are familiar with current optimal peri-surgical pain management to optimize the patient's experience and minimize complaint.

Article

The definition of pain is that it is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (International Association for the Study of Pain, IASP).1 Please dwell on this definition, it proposes that pain can potentially occur with no physical damage (for example, have any of you been dumped by text?) or at the prospect of impending pain (for example a forthcoming visit to the dentist). Your brain is the ‘boss’ of pain, as without a brain you won't feel pain! Your little finger or tooth doesn't feel the pain, it's the brain's somatosensory cortex that overlays the pain experience on the digit or tooth that is in danger, to effect appropriate protective behaviours (including removing your digit from harm or escaping the dental chair!). The brain tells whatever part of your body that's getting hurt to move away from the cause. When this system is disconnected, that is when healthy healed tissue continues to ‘feel‘ pain, which is due to the brain continuing to overlay the pain to the healthy tissues. This is the cause of chronic or pathological (also suspected to be due to central sensitization) pain.

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