Katja Milati

An

unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Physical

or mental suffering or distress with a variety of sources

 The The

pain perception threshold - stimulus pain tolerance threshold - subject acts to

begins to hurt stop the pain

Hypokinetic

high tolerance Hyperkinetic low tolerance

To go or not to go?

Misconceptions: 1: Patients who are in pain always have observable signs.

2: Obvious pathology, test results, type of surgery determine the existence and intensity of pain.
3: Patients should wait as long as possible before taking a pain medication. The abstinence will teach them to have a better tolerance for pain.

>Patients should be encouraged to use anlgesisc before the pain gets severe and difficult to control!<

 The

practice of various psychological, physical, and chemical approaches to the prevention and treatment of preoperative, operative, and postoperative anxiety and pain.

Allows

the dental treatment to occur in a safe and effective manner.

 Psychological

methods - anxiety abatement

(hypnosis, relaxation managment, distraction methods, vocal calming...)

Pharmacological

methods: Sedation (antianxiety agents, intravenous sedation, inhalation sedation) Analgesia (non-opioid, opioid) Local anesthesia General anesthesia

Also called sedatives:

-

Depress the central nervous system by increasing the GABA activity

Benzodiazepines (diazepam- Valium,Apaurin,

Normabel, alprazolam- Xanax)

Barbiturates Other:

- less selective, mostly opsolent

(secobarbital- Seconal)

hypnotic- for children (chloral hydrate-

Noctec) .....

NONOPIOID OR NONNARCOTIC

OPIOID OR NARCOTIC

NONSTEROID ANTIINFLAMMATORY DRUGS (NSAIDs)

act

on perihperal nerve endings

inhibiton of ciclooxigenasis inhibition of prostaglandin synthesis

Effects: analgetic antipyretic antiinflammatory

acetylsalicylic acid (Aspirin, Andol)

acetaminophen (paracetamol) (Lekadol, Lupocet, Tylenol) ibuprofen (Neofen, Brufen, Nurofen)

naproxen (Nalgesin, Anaprox, Naprosyn)

ketoprofen (Ketonal)

Affect the central nervous system

Bind to opioid receptors

Supraspinal analgesia Spinal analgesia Many side effects...

morphine

Papaver somniferum (opium poppy)

codeine (in Caffetine, in Plivadon, in Tylenol #3)

oxycodone (Oxycontin, Percodan, Roxipin) meperidine (pethidine) (Dolantin, Demerol) methadone (Heptanon, Dolophine)

Repeted use of opioids may lead to analgesic tolerance and addiction!

 Greek: an-without

athesia- feeling

Loss of sensation in a specific area of the body without the loss of consciousness Local anesthetics reversibly block the generation and conduction of nerve impulses to central nervous system.

 Aminoesters

(cocaine, benzocaine, procaine/novocaine, tetracaine)

Aminoamides

(articaine, bupivacaine, lidocaine, mepivacaine, prilocaine...)

 added

to local anesthetic solutions minimise systemic absorption prolong the duration of anesthesia decrease bleeding during surgical procedure epinephrine (adrenaline) (1:50 000 1:250 000)

 Topical

anesthesia: apllied on the surface of oral mucosa, in sprays, liquids or ointments

anesthesia: achieved by injecting the anesthetic solution in the tissue near the terminal nerve endings

Infiltration

Block

anesthesia: the solution is injected near a major nerve, and the entire area served by that nerve is numbed.

Maxillary nerve block: Posterior superior alveolar Infraorbital Nasopalatine Greater palatine Maxillary (2nd division) Other blocks Mandibulary nerve block: Inferior alveolar-lingual Mental-incisive Buccal Gow-Gates Closed mouth

 Intraosseous

- for a single tooth or a few teeth in the same quadrant, also for mandibular molars, directly into the spongy bone Periodontal ligament (intraligamentatory) mainly in mandible arch for one or two teeth in quadrant, often as a supplement for a failed block anesthesia

 Computer-controlled

local anesthetic delivery (CCLAD) The Wand computer controlls the flow of the anesthetic solution through the needle
anesthesia - A noninvasive method (no needles!) to block pain electronically by using a low current of electricity through contact pads that target a specific electronic waveform directly to the nerve bundle at the root of the tooth

Electronic

 controlled

state of unconsciousness with loss of protective reflexes resulting from the administration of one or more general anesthetic agents.

Inhalational anesthetics maintenance

nitrous oxide and oxygen gas (NO/O) anlgesia (stage I) desfluran, isoflurane, sevoflurane halothane, enflurane...

Intravenous anesthetics mostly introduction (various drugs)

thiopentone/thiopental (barbiturate) medazolam (benzodiazepine) propofol etomidate ketamine fentanyl (opioid)

Hypnosis Amnesia Analgesia Relaxation of sceletal muscles Loss of control of reflexes of the autonomic nerve system

Stage I: Analgesia - relaxed but conscious, able to carry on a conversation.

Stage II: Excitement - less aware of surroundings and starts to become unconscious, can become excited and unmanageable , delirium. Undesirable stage.
Stage III: General anesthesia - the patient becomes calm, unconscious, feels no pain or sensation. (Only under the guidance of an anesthesiologist in a controlled environment such as a hospital!)

Stage IV: Respiratory failure or cardiac arrest the lungs and heart slow down or stop functioning. If this stage is not reversed quickly, the patient will die.

THANK YOU FOR LISTENING!