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How to deal with pain during dental treatment
09-09-2009
Prevention of pain and emotional stress is one of the most pressing problems in dentistry.
The high prevalence and intensity of dental caries and its complications and other dental diseases is forcing almost everyone to go for help to the dentist. Often the medicine was accompanied by the fear of the patient before surgical operations, discomfort and pain. All this can provoke the emergence during the intervention of various complications of a general nature, as well as in further aggravation of chronic and comorbid conditions of patients.
Pain – is a multicomponent reaction of the organism that occurs during the action on the tissues of strong stimuli. The main characteristics of conventional pain are: sensory, psycho-emotional, vegetative, psychomotor.
With the impact of the main components of pain is possible to achieve effective analgesia, removal of psycho-emotional and psychomotor reaction, the normalization of the autonomic system of the patient, thereby reducing the frequency and severity of complications, increases the effectiveness of analgesia, facilitates the work of a doctor.
When the impact on the sensory component should be considered less traumatic intervention, especially the sensitivity of tissues exposed to, the state of internal systems for the regulation of pain sensitivity.
Sensory component of pain reaction can be blocked with a centrally acting analgesic agents, lokal anaesthetization drugs, as well as by activation of internal Pain system.
The most effective method of influence on the pain – it is local anesthesia, which, however, is not always effective, which may be due to the lack of knowledge of anesthesia equipment, a high degree of emotional stress of the patient, the location variability of the branches of the trigeminal nerve, low efficiency of anesthetic substances, structural features of the hard tissue teeth, the presence of inflammation.
To increase the effectiveness of local anesthesia, and, consequently, the prevention of emotional pain and stress in the choice of the anesthetic is preferable to use the amide anesthetics (trimekain, lidocaine, ultrakain, ksilokain, etc.) which are much more pronounced anesthetic effect, as compared with aromatic anesthetics ( novocaine).
To enhance the anesthetic action is necessary to add vasoconstrictor, particularly in the presence of an inflammatory process, when, in addition to reducing the activity of the anesthetic, it is noted and its rapid absorption. However, the use of vasoconstrictors must be justified, and if there is a heightened sensitivity to adrenaline (in patients with endocrine, severe cardiovascular disease) should be used norepinephrine, vasopressin, and must implement appropriate premedication. In addition, to reduce the side effects should strive to reduce the amount of anesthetic (and, accordingly, vasoconstrictor) by changing the technique of anesthesia, using, for example, intraligamentarnuyu anesthesia (as indicated).
Great importance in povtshenii effectiveness of local anesthesia is the optimal choice of the method in each case. The effectiveness of pain relief, reduce the number of simultaneously injected the drug, and, consequently, reduce the number of complications, and promotes the use of modern instruments and syringes.
In many cases, the ineffectiveness of local anesthesia due to psycho-emotional stress patients before dental procedures. As a result of stress in the body can develop state giperalgezii, and then even a weak stimulus can be identified with the pain. Therefore, initially before anesthesia and intervention must be addressed psycho-emotional stress of the patient with medication and other means. This will, in addition to improving the effectiveness of pain relief, reduce the frequency and severity of psychovegetative complications.
As the impact on psycho-emotional factor pain reaction used sedatives, have a weak sedative effect, and tranquilizers, which selectively inhibit fear and anxiety. Preparations benzodiazepinovogo series (Seduxen, Relanium, apodiazepam, Sibazon) related to tranquilizers, causing emotional calm, cropped psychomotor agitation, slightly lower blood pressure, have antihypoxia action, as well as normalize the work of the Pain System, thereby creating a reliable neuro protection. With sharply expressed psycho-emotional state tranquilizers appointed with analgesics and cholinolytics.
Stress state of the patient on the dental admission due to fear of interference and pain, increases the reactivity of the autonomic system, which manifests itself in the first place, insta ¬ susceptibility of vascular tone. For the prevention of autonomic complications in dental practice are crucial carefully collected history and physical examination data general condition at the time of intervention, which allow doctors to identify patients at the predominance of the manifestations of sympathetic or parasympathetic reactions.
In patients with neurocirculatory dystonia of hypotonic type during the intervention may have a faint, collapse. To prevent these oslozheny such patients in the sedation, in addition to tranquilizers, it is necessary to introduce group cholinolytics drugs (atropine sulfate 0.1%, metatsin), which avoid circulatory disorders, and bronchospasm.
If a patient has high blood pressure, hypertension in the sedation is introduced, in addition to a sedative, spasmolytic drugs.
Since a significant number of patients on admission are associated dental disease, the dentist should be alert to various complications that may arise during and after dental care to these patients.
In this regard, patients with allergic, endocrine, cardiovascular diseases, bronchial asthma, epilepsy shows premedication, which is the basis of impact on psycho-emotional reaction (tranquilizers). In sedation also require pregnant women. Mandatory premedication (tranquilizers, analgesics, and heart funds) to patients with inflammatory diseases of the maxillofacial region.
Must implement premedication in children, that allows to raise the threshold of pain sensitivity, film psycho-emotional stress and inhibit vegetative manifestations.
For the prevention of pain in dentistry is very important application of new methods of anesthesia, such as reflex analgesia. Stimulation neuroreceptor causes activation of endogenous Pain system, which blocks the transmission of pain sensitivity. In dentistry, the most common method of electric influence, which, together with an analgesic, has immunostimulant and regenerating effect.
Using the method of percutaneous electroneurostimulation can advance to prevent the development of pain or at the first signs (during the sealing of channels with traumatic tooth extraction) are not allowed to develop. This method may be the method of choice of anesthesia in ambulatory dentistry, especially in patients with allergies to local anesthetics, with exacerbation of psycho-emotional reaction to the anesthetic injection, patients with stomatonevrologicheskoy disorders and other conditions.
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