Analgesia in Dentistry Flashcards
When should we start systemic analgesics?
Before the LA wears off
Name examples of NSAIDs (3)
- Aspirin
- Ibuprofen
- Diclofenac
What was aspirin used for dentally
Dental + TMJ pain
What drug is used more commonly in dentistry now?
Ibuprofen
List some aspirin properties (4)
- Analgesic
- Antipyretic
- Reduces elevated temp in fever - Anti-inflammatory
- Reduces redness + swelling as well as pain at the site of injury - Anti-platelet
Function of prostaglandins
They don’t cause pain directly but they sensitise the tissues to other inflammatory products
Mechanism of action for aspirin
- Reduces production of protaglandins
- Inhibits COX1+2
- COX1 inhibition reduces platelet aggregation
List some adverse effects of aspirin (4)
- GIT problems
- Mostly on mucosal lining of stomach
- Care taken when prescribing for pts with ulcers/gastro-oesophageal reflux - Hypersensitivity
- Acute bronchospasm
- Minor skin rashes
- Care when prescribing to asthmatics - Overdose
- Hyperventilation
- Vasodilation + sweating
- Tinnitus + deafness - Aspirin burns - mucosal
- When aspirin is applied locally to oral mucosa this results in chemical burns
What groups to avoid for aspirin?
- Peptic ulceration
- Epigastric pain
- Bleeding abnormalities
- Anticoagulants
- Pregnancy/breastfeeding
- Risk of haemorrhage + jaundice in baby - Patients on steroids
- Renal/hepatic impairment
- Children under 16
- Taking other NSAIDs
What drug should not be prescribed post extraction/minor oral surgery?
Aspirin
What drug should be prescribed post operatively?
Ibuprofen
Aspirin dose for mild/moderate odontogenic or inflammatory pain?
5 day regimen
40 tablets 300mg
2 tablets 4x daily after food
NSAID prescription for a hx of previous or active peptic ulcer disease for tx of odontogenic pain?
5 day regimen to prevent gastric problems
Lansoprazole capsules
15mg
5 capsules 1 daily
OR
Gastro-resistant omeprazole capsules
20mg
5 capsules 1 daily
NEITHER are licensed for children
Ibuprofen dose for mild/moderate odontogenic post op or inflammatory pain?
5 day regimen
400mg Ibuprofen
20 tablets
1 tablet 4x daily after food
Whats the max dose of ibuprofen in adults?
2.4g
List some ibuprofen potential drug interactions
- ACE inhibitors
- Antibiotics
- Anticoagulants
- Antidepressants
- Beta blockers
- Ca channel blockers
- Ciclosporin
List some symptoms of ibuprofen overdose (3)
- Nausea
- Vomiting
- Tinnitus
How do NSAIDs work?
Inhibit COX and so reduce prostaglandins (which sensitise other tissues to other inflammatory mediators, resulting in pain)
What are non selective NSAIDS contraindicated in?
Patients with a hx of peptic ulceration
How does paracetamol differ to ibuprofen and aspirin?
Little or no anti-inflammatory action
Paracetamol dose for mild.moderate odontogenic or post op pain
500mg tablets
40 tablets
2 tablets 4x daily
Where do opioid analgesics act?
On the spinal cord
They are relatively ineffective in dental pain
What are some opioid analgesics problems? (2)
- Dependence
- Withdrawal leads to cravings - Tolerance
- Keeps increasing
Most common opioid side effects (3)
- Nausea
- Vomiting
- Drowsiness
What group of people should we be cautious for opioids? (4)
- Hypotension
- Hypothyroidism
- Asthma
- Pregnancy
When should dihyrocodeine never be prescibed?
In patients with raised intracranial pressure/suspected head injury
Why do we avoid dihydrocodeine?
Due to side effects of nausea + vomiting its of little value for dental pain
It’s not very effective for post-op dental pain
Whats the main drug used for trigeminal neuralgia?
Carbamazepine
