6 Pain Management in Dentistry

Question 1

what tract is responsible for localization of pain

Answer 1

spinothalamic tract

Question 2

what tract is responsible for emotional aspect of pain

Answer 2

spinoreticular tract

Question 3

etiology of dental pain

Answer 3

1. bacteria - toxins, metabolic by-product
2. trauma - physical, chemical, thermal
3. hosts response - to insult - inflammation, infection

Question 4

majority of “tooth” pain is truly ___

Answer 4

odontogenic

Question 5

types of odontogenic pain

Answer 5

pulpal and periodontal

Question 6

pulpal types of tooth pain

Answer 6

1. hypersensitivity
2. reversible pulpitis
3. irreversible pulpitis
4. pulpal necrosis

Question 7

periodontal type of tooth pain

Answer 7

1. gingival abscess
2. periodontal abscess - impaction BUT bone loss is present
3. pericornitis
4. occlusal trauma

Question 8

data collection pathway

Answer 8

1. interview
2. clinical examination
3. radiograph examination
4. reproduce the pain in the office

Question 9

what should you do during a clinical examination

Answer 9

extraoral examination AND intraoral examination WITH palpation

Question 10

examples of radiographicc examination

Answer 10

periapical PA

Question 11

what should you do when reproducing pain

Answer 11

do what patient say is causing pain

Question 12

symptoms of hypersenitivity

Answer 12

sharp, non-lingering, intense pain to stimuli

Question 13

symptoms of reversible pulpitis

Answer 13

non-lingering pain to thermal stimuli, biting, percussion

Question 14

symptoms of irreversible pulpitis

Answer 14

lingering/spontaneous pain to (esp. HEAT) thermal, biting, percussive, palpation stimuli

Question 15

symptom of pulpal necrosis

Answer 15

spontaneous throbbing with no response to testing OR asymptomatic, no reponse to testing, fistula, radiolucency

Question 16

symptoms of gingival abscess

Answer 16

pain (duller than pulpal), edema, erythema, bleeding

Question 17

symptom of periodontal abscess

Answer 17

pain, edema, erythema, bleeding BUT bone loss (abscess is usually localized)

Question 18

symptom of pericornitis

Answer 18

extremely painful, trismus (bilateral restriction of mouth opening)

Question 19

symptom of occlusal trauma

Answer 19

pain or tenderness on biting, cusp fracture, abfraction

Question 20

for managing dental pain, what is the most important thing to remember

Answer 20

treatment plan must be based on diagnosis x3

Question 21

NSAIA

Answer 21

nonsteroidal anti-inflammatory agent

Question 22

different of mechanism of action of NSAIA vs. opioids

Answer 22

NSAIA: produces pain, inflammation, fever as part of healing process

OpioidS: perception of pain is altered

Question 23

when is it appropriate to uses antibiotics?

Answer 23

when local measures cannot be carried out immediately and the patient has SYSTEMIC INVOLVEMENT