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Section Questions and Answers

Pain Control

"Oral facial pain ... is a major source of diminished quality of life. It is associated with sleep deprivation, depression and multiple adverse social outcomes." U.S. Surgeon General's Report

Pain is controlled in dentistry in four different ways:

  1. Local anaesthesia
  2. Conscious sedation
  3. General anaesthesia
  4. Analgesics or pain relievers

 
1. Local anaesthesia

There are two methods of inducing local anaesthesia.

  • Syringe and hypodermic needle method
    • This is the most common method of controlling the discomfort of dental treatment.
    • An anaesthetic cream or gel is first used to numb the gum, and to make the injection almost painless.
    • The anaesthetic solution is injected into the tissues, after which the treatment can be painless.
    • The lips, tongue and cheek may also be numbed, as they share a common nerve supply.
    • The face, lip and tongue may feel swollen although they do not actually swell.
    • Do not eat while you still feel numb, because you may bite your lip or cheek.
    • Avoid hot drinks while your mouth is numb as you could burn yourself without realising it.
    • The numbness lasts for 1-4 hours.

  • High pressure jet method
    • This special device delivers the anaesthetic solution under pressure, without using a needle.
    • It may be used as the sole means of inducing anaesthesia, or to numb the gum before a conventional injection.

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2. Conscious sedation

  • This is a method of reducing the anxiety and pain of dental procedures.
  • There is no loss of consciousness.
  • There are two methods of inducing conscious sedation:
  • Inhalation sedation
    • The patient inhales a very safe concentration of nitrous oxide and oxygen and feels very relaxed. Pain is greatly diminished.
    • A pleasant floating feeling is experienced, hence the name "happy gas" given to nitrous oxide.
    • Inhalation sedation is sometimes used together with a local anaesthetic, resulting in a completely pain free treatment.
    • Normal activities can be resumed shortly after inhalation sedation has ended.
  • Intravenous sedation
    • This is administered by injection into a vein in the arm.
    • There is no loss of consciousness, but anxiety and pain are greatly diminished to allow a pain free session.
    • There may be no memory of what happened during the treatment.
    • Intravenous sedation results in drowsiness after the treatment. It is therefore necessary to be accompanied on the way home.
    • Driving is not advised for at least 24 hours.

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3. General anaesthesia

  • General Anaesthesia allows the dentist to work on an unconscious patient.
  • It may be necessary when the treatment is particularly painful or difficult.
  • If the patient's emotional or behavioural problems make it impossible for the dentist to carry out the treatment in the surgery, a general anaesthetic can solve the problem.
  • General anaesthesia should only be used in a hospital or similar environment, and be administered by a specialist anaesthetist.

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4. Analgesics or pain relievers

  • An analgesic is a pain relieving substance. It does not cure the dental problem that causes the pain, but reduces the feeling of the pain.
  • It is used as short-term measure to ease pain, before and after dental treatment.
  • Some dental procedures can result in a degree of pain and discomfort after treatment. Pain relievers play a part in making the treatment more comfortable.
  • The main cause of severe dental pain is an inflammation of the nerves and blood vessels, both in and around the tooth. It is usually associated with tooth decay.
  • Anti-inflammatory drugs such as Aspirin and Ibuprofin are effective for such pain.
  • The most commonly used analgesics are Acetaminophen (also called Paracetamol or Tylenol), Aspirin, Codeine and Ibuprofen.
  • It is advisable that analgesics should only be taken with the knowledge and approval of your doctor or dentist. This is particularly important if you are taking other medications as well.
  • Many analgesic preparations can be bought without a prescription, but caution is nevertheless necessary.
  • Several analgesics are very often combined within a single tablet or capsule.
  • You must be aware of the ingredients of your pain-relieving tablets or capsules, and not exceed the recommended dose.

See Analgesics for more information

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