Hands OnPain management
Section snippets
Background
Limited information is available on the role of medication in treatment outcome and patient experiences related to dental implant placement. The causes of orofacial pain and the means of managing such pain were reviewed to determine what medications are recommended for use.
Orofacial Pain Mechanisms
The unavoidable tissue damage caused by the surgical placement of dental implants can produce pain through the initial surgical insult and/or because of the subsequent inflammatory process. The surgery crosses the threshold of nociceptors in the periodontal and osseous tissues and mediates an acute pain sensation that is eventually transmitted to higher central nervous system (CNS) centers. Inflammatory pain is normally characterized as dull or throbbing and reaches its greatest levels about 48
Postoperative Pain Experience
Various factors will influence the pain experience of patients after implant placement. Patient factors include gender, anxiety levels, and smoking status, all of which may exacerbate pain perception. Surgical factors that increase pain include grafting technique, number of implants placed, posterior siting of implant, excessive heat generation, extent of surgical flaps, poor flap management, and over-torquing of the implant (Table 1).
Treatments
The medications useful in managing these pain experiences include non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, opioids, and corticosteroids. The efficacy of the various postoperative analgesics for implant procedure pain varies.
NSAIDs exert an analgesic effect by inhibiting the action of one or both of the isoenzymes of the cyclooxygenase enzymes COX-1 and COX-2. Production of the pain-mediating prostaglandins and thromboxane is then reduced. COX-2 inhibition is vital to pain
Adjunctive Agents
The use of ibuprofen, paracetamol with or without codeine, and diclofenac prophylactically can reduce pain immediately after surgery. A third of patients have experienced a 50% reduction in pain using postoperative single doses of ibuprofen or diclofenac. However, single-dose analgesics are rarely successful at achieving complete postoperative pain control, with “rescue” analgesics often needed to achieve relief. Adjunctive agents include long-acting local anesthetics, which can supply up to 8
References (0)
Cited by (0)
Bryce G, Bomfim DI, Bassi GS: Pre- and post-operative management of dental implant placement. Part 1: Management of post-operative pain. Br Dent J 217:123-127, 2014
Reprints available from G Bryce, Restorative Dept, Eastman Dental Hosp, 256 Gray’s Inn Rd, London WC1X 8LD; e-mail: [email protected]