Pain During Periodontal Therapy

When a procedure as basic as scaling and root planning and the sight of reduced post-operative inflammation – seeing the gingiva turn to a benign pink from red gives you a sense of fulfillment and satisfaction that is incomparable, you know that being a Periodontist is everything you have ever wanted. Holding a scalpel, incising the gingival and periodontal tissues and raising a flap almost perfectly for the very first time, is perhaps one of the most exhilarating experiences I have ever had and, at the risk of sounding too dramatic, the clockwise and anti-clockwise turning of the wrist during suturing is nothing short of sheer poetry in motion to me.

Today I worked on my patient Evelyn Serrano. I started and finished periodontal instrumentation. During the morning section I started with a power instrumentation of the maxillary arch, followed with the application of the topical anesthetic oraqix. As part of treatment, chronic periodontitis includes Scaling and Root Planing (SRP), which is experienced by a significant number of patients as painful and uncomfortable. Occasionally, topical anesthetics such as Oraqix is used in order to reduce pain and discomfort. Oraqix consists of an eutectic mixture of 5% lidocaine and prilocaine (each gram contains 25-mg lidocaine and 25-mg prilocaine. Consequently, the anesthetic material is liquid at room temperature and chances into a gel at body temperature. The anesthetic solution is applied on the

The prudent dentist must be aware of the mechanisms and clinical symptoms of referred pain, peripheral sensitization, central sensitization, and convergence. This knowledge will aide the clinician to be able to properly diagnose non-odontogenic oro-facial pain in order to treat the patient properly and to avoid doing irreversible harm to the patient, such as extractions or endodontic treatment on healthy

Occlusal discrepancy is just a difference in the way teeth normally fit together. Some examples would be overjet, overbite, open bite, cross bite, and under bite. It has been found that these occlusal discrepancies may play a role in the progression of periodontal diseases. Some research has been done on the relationship of these two aspects but it is very controversial and more research needs to be performed before a definite answer can be provided.

Recommend and briefly justify an appropriate analgesic for mild-moderate dental pain. Include why you would or would not choose a

Adults age ≥65 years tend to have higher rates of periodontal disease than younger age groups3

Sixteen patients (72%) in saline group had moderate to severe pain. Two patients (9%) in ondansetron group and one patient (4%) in lidocaine group had mild pain (P= 0.06). No patient in lidocaine, ondansetron and combination group had moderate to severe pain

There's no reason why pain free dentistry should be mysterious. In fact, gaining insight into it can be fairly simple. All it requires is some research, understanding the procedures, and being willing to talk to your dental surgeon. Remember: pain-free dentistry is no longer an oxymoron.

Local anaesthetics are naturally vasodilators; that makes their action shorter and less profound. Adrenaline with its vasoconstrictive role increases the depth and the duration hence makes the action of local anaesthetic more profound. 1,2,3,4,9 This action is governed by many factors like the type of the anaesthetic used, the concentration of the epinephrine and site of injection. For example, one study shows that the use of the 1% Lidocaine with 1: 100 000 epinephrine has better anesthetic effect in maxilla if compared with 4% Articaine without epinephrine. The same review reports a study that shows 1% Lidocaine without epinephrine doesn’t have an effect when used for infiltration in the maxilla.1 In the mandible, one study shows that epinephrine in a concentration of 1:100 000 significantly affects the duration and onset of action of 4% Articaine. The author argues that other aspects such as intra and post-operative pain and injection pain remain unaffected. Hence it is suggested that when this property is not needed, such as in simple extractions of lower teeth, IANB with plain 4% Articaine can work well. 11Another beneficial effect of epinephrine is related to producing hemostasis that helps with the visibility of the working area and hence increases the efficiency and accuracy of certain procedures.9 It is evident that this effect is primarily governed by the concentration of the epinephrine and the

There are various discomfort that a patient who undergoes an orthodontic treatment experiences. This discomfort may be due to the result of tension, functional restrictions or psychological dislike to wear the orthodontic appliance in the public. Common causes of orthodontic pain are the placement of the separators, alterations in the periodontal ligament and surrounding soft tissues, wire placement, appliance activation, Debonding of an orthodontic appliance. For the management of orthodontic pain, there are several ways such as analgesics, low-level therapy, vibratory forces, bite wafers, anesthetic gels, chewing gums, medicated wax, behavioral therapy.

Aggressive periodontitis is a form of periodontal disease which involves rapid destruction of the periodontal ligament and alveolar bone. This disease normally affects the younger population, but may be found in the older population. Those affected suffer from early tooth loss, reduction in tissue and increased of microorganisms such as Aggregatibacter actinommycetemcomitans(Aa), Porphyromonas gingivalis(Pg), and Prevotella intermedia(Pi). Scaling and root planning (SRP) have been considered the gold standard in eliminating bacterial plaque (Annaji et al., 2016, p. ZC08). According to Annaji et al, with the recent development of antibiotic resistance there has been an increase use of lasers and photodynamic therapy (PDT) as non-invasive therapeutic

There are numerous conditions which could result in the pain experienced by a patient who reports a “toothache”. Many times, an odontogenic etiology—such as caries, cracked tooth, infection, or periodontal abscess—for the pain can be identified, treated, and resolved. However, in some cases, there is no odontogenic etiology for the pain, requiring a more complicated differential diagnosis. After eliminating the possibility of odontogenic conditions by examination, radiography, and pulp tests, several other conditions should be considered.

In this paper, I am going to discuss about Mr DB who presented to the dental clinic for a scale and debridement for his moderate generalised chronic periodontal disease. Apart from his periodontal disease, the known health issues that Mr DB has include poorly controlled diabetes, which is most likely to be type 2 according to the medication that he is taking, and class 2 obesity, considering his weight and height. He is also likely suffering from hypercholesterolemia, hypertension and constipation considering the medications that he takes. Despite his health conditions, Mr DB has issues with his diet as his diet involves frequent consumption of sugar and minimal intake of vegetables and no fruits. The choice of food is also highly shifted to high GI food and saturated fat, and these factors can have bad impact for his health conditions and hence need to be modified accordingly. Mr DB has also social determinants which may be related (associated) to the health conditions that he has. These include risky health behaviours such as lack of physical activity, life course events such as

The goal of periodontal therapy is to provide the patients with a dentition that functions in health and comfort for the remainder of their lives. Ideally, periodontal therapy should resolve inflammation, arrest progression of disease, maximize patient comfort, maintain aesthetics, and regenerate lost periodontal support1.

When you have tooth pain and cannot immediately see a dentist, you may scour the internet for home remedies to take away the pain until you can see your dentist. You can find a lot of anecdotes online for easing oral pain, but be sure to choose the pain remedies that will not damage an already damaged tooth any further. Here are some tooth-pain home treatments that will only worsen your damaged tooth and should always be avoided.