Home Treatment of Tooth Pain
Oro-dental pain as a specific modality (Clark 2006) and a cardinal sign occurs as a result of inflammation and traumatic injuries or as a complication of elective oral and maxillofa-cial surgery. Toothache has been compared with earache and labor pain for its intensity and propensity for acute discomfort. Common diseases affecting the oral structures are dental caries and gum disease, oral ulcers, and dentine hypersensitivity. The need for regular oral care by the patient and preventive visits to the dental office cannot be overemphasized since the above disorders can lead to a host of complications, which can include intractable pain. Dental caries is known to be the highest incidence of any disease that besets mankind. Orson had called this the triple tragic triangle of tooth decay and had implicated fermentable carbohydrates, oral bacteria, and susceptibility of the individual. Tooth decay can progress by a burrowing effect, ultimately destroying the dentin, and reaches the nerve...
Virtual user groups The BNF has set up virtual user groups across various healthcare professions (e.g. doctors, pharmacists, nurses, dentists). The aim of these groups will be to provide feedback to the editors and publishers to ensure that BNF publications continue to serve the needs of its users.
Branded oral liquid preparations that do not contain fructose, glucose, or sucrose are described as 'sugar-free' in the BNF. Preparations containing hydrogenated glucose syrup, mannitol, maltitol, sorbitol, or xylitol are also marked 'sugar-free' since there is evidence that they do not cause dental caries. Patients receiving medicines containing cariogenic sugars should be advised of appropriate dental hygiene measures to prevent caries. Sugar-free preparations should be used whenever possible.
Administration of the test needs to be carefully monitored, to make sure that no more than one word is selected from each subclass and to ensure that the patient understands each word. Patients for whom English is not their first language have particular difficulty with this test, although foreign language versions are available. The short form (SF-MPQ) has gained in popularity due to its brevity and good reliability.22 The SF-MPQ consists of 15 representative words from the sensory and affective categories of the original MPQ as well as an additional word splitting'' because it is a discriminant word for dental pain. The SF-MPQ is sensitive to clinical changes from therapeutic interventions.23 II
Acute pain is a set of unpleasant and emotional experiences often culminating in behavioral responses. Acute pain is, invariably, produced by disease, injury, noxious chemicals, or some physical stimulation (e.g., heat). Much of our knowledge about acute pain has been acquired from studies of experimentally induced pain in laboratory animals or even human volunteers. Clinical situations such as acute dental pain, the pain of parturition, and many postsurgical situations have also been an impetus to research.
Aspirin 5.14 is the best known of a family of drugs that are known as the non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are used because of their analgesic (pain-killing), anti-inflammatory and anti-pyretic (fever reducing) properties. Aspirin has its origins in folk medicine. Chewing the bark of the willow tree (Salix europea) alleviated pain associated with rheumatism, toothache and headache. Salicin 5.15 and salicylic acid 5.16 were originally isolated from this source. They were used in the nineteenth century for the treatment of rheumatic fever and for their anti-pyretic and anti-inflammatory properties. Salicylic acid became readily available from phenol 5.17 by the Kolbe reaction. However, it produced side effects involving gastrointestinal damage. It was found that acetylation reduced these side effects and aspirin was introduced in 1899. Other salicylates derived from natural sources have useful anti-inflammatory action. Oil of wintergreen (methyl salicylate) is...
The correct diagnosis of TN is important because there are specific treatments related to this condition (see under Management and prognosis). A number of orofacial pain conditions can be mistaken for TN. The most common will be dental types of pain in their acute stage. Therefore, it is mandatory to rule out dental pathology using clinical examination radiographs in order to avoid unnecessary tooth extractions. Atypical facial pain or atypical odontalgia (persistent idiopathic facial pain) can also mimic TN, but usually the pain is more constant persistent without paroxysms characteristic for TN. Sinusitis and acute ear infections (otitis externa, otitis media) also need to be ruled out by the general history and examination.
During examination of a patient with chronic facial pain, many different pain conditions, for example dental pain, must be ruled out in order for the patient to receive a diagnosis of AFP. Sometimes, diagnostic local anesthetic blocks can be useful when dental pathology is suspected to cause the facial pain. Pain originating from the maxillary sinuses often cause pain in the mid-facial region and can be ruled out by nasal endoscopy, x-ray, or computed tomography (CT) of the sinuses. Examination of the masticatory muscles and the temporomandibular joint with palpation over joint and muscles, as well as evaluation of jaw function can reveal the presence of TMD. TN can usually be distinguished from AFP by the symptomatology. Trigeminal neuralgia patients are pain-free most of the time and suffer from attacks with short-lasting, shock-like pain paroxysms (see under Trigeminal neuralgia), whereas AFP pain is constant and non-paroxysmal. Furthermore, TN, and not AFP, is characterized by the...
Randy is a patient normally seen in the primary care clinic. He has diabetes and has recently been diagnosed with cancer for which he is undergoing chemotherapy. He recently came in for his appointment and started to describe a new pain in his feet that was much worse and ached liked a toothache. He said his feet were numb and many times he could not tell he had injured a foot, and needed to be very careful so as not to hurt himself. His hands were starting to have a painful pins and needles pain that seemed to be getting worse.
They may exaggerate or feign medical problems, for example, complain of renal colic and prick a finger to add blood to the urine specimen, so you might believe a renal stone was not visible on x-ray. Their complaints may be hard to determine objectively, such as a migraine, tic, or toothache.
Polysaccharide, i.e., glycogen or amylase) which results in brown to purple staining. The ability of oral bacteria to store iodophilic polysac-charides or glycogen-like molecules inside their cells is associated with dental caries since these storage compounds may extend the time during which lactic acid formation may occur. This prolonged exposure to lactic acid results in decalcification of tooth enamel. However, biofilms also contribute to bio-corrosion are associated with tooth decay and are responsible for infections of the human body. With regard to bio-corrosion, sulfate-reducing bacteria (SRB), such as Desulfovibrio vulgaris, contribute to the corrosion of steel. The presence of Streptococcus mutans in dental plaque is a hallmark of dental caries. Also, biofilms account for more than 80 of all microbial infections of human body. Nevertheless, the use of oral biofilms rather than individual oral bacterial species provides a more accurate view of the pathogenic events that take...
However, robust research evidence is needed to implicate periodontal disease as a major culprit. Preventive oral health and dental pain management have become a priority in these special groups of patients as an integral part of antenatal care and cardiac rehabilitation programs.
Summary Emerging results from clinical and basic research indicate that persistent pain results in changes in the central nervous system. This article reviews data that support the use of tricyclic antidepressants for neurogenic or atypical pain, and benzodiazepines for musculoskeletal pain. Other topics covered include the pathophysiology of persistent pain and the pharmacological management of temporomandibular disorders (TMDs) with antidepressants, benzodiazepines, muscle relaxants, non-opioid analgesics, corticosteroids, and opioids. The authors stress that dentists must weigh the benefits of the chronic administration of a drug for the management of TMDs against the equivocal scientific support for the use of many drug
A condition called persistent idiopathic facial pain has been described in The International Classification of Headache Disorders, 2nd edition, by The International Headache Society (IHS).109 This term covers the diagnoses atypical facial pain (AFP) and atypical odontalgia (AO). Burning mouth syndrome (BMS) is separate from AFP and AO in the IHS classification but is often grouped together with these conditions and sometimes also with TMD as being so-called idiopathic, i.e. medically unexplained orofacial pain conditions.84,110,111
Medicaments left in contact with or applied directly to the oral mucosa can lead to inflammation or ulceration the possibility of allergy should also be borne in mind. Aspirin tablets allowed to dissolve in the sulcus for the treatment of toothache can lead to a white patch followed by ulceration.
Patients may present with pain in the orbit that may or may not be associated with eye movement. Ocular pain and photophobia may be associated with corneal irritation or abrasions. Pain in the eye may also arise from increased intraocular pressure which occurs in glaucoma. Dental pain and temporal giant arteritis can be referred to the eye. Pain from the greater occipital nerve may be referred to the eye and face. If eye pathology is suspected, patients should be evaluated by an ophthalmologist.
The BNF uses about 60 expert clinical advisers (including doctors, pharmacists, nurses, and dentists) throughout the UK to help with the production of each edition. The role of these expert advisers is to review existing text and to comment on amendments drafted by the staff editors. These clinical experts help to ensure that the BNF remains reliable by
The most common effect that drugs have on the salivary glands is to reduce flow (xerostomia). Patients with a persistently dry mouth may have poor oral hygiene they are at an increased risk of dental caries and oral infections (particularly candidiasis). Many drugs have been implicated in xerostomia, particularly antimuscarinics (anticholinergics), antidepressants (including tricyclic antidepressants, and selective serotonin re-uptake inhibitors), alpha-blockers, antihistamines, antipsy-chotics, baclofen, bupropion, clonidine, 5HT, agonists, opioids, and tizanidine. Excessive use of diuretics can also result in xerostomia. Some drugs (e.g. clozapine, neostigmine) can increase saliva production but this is rarely a problem unless the patient has associated difficulty in swallowing.
Redistribution of Na1 channels.82 Gabapentin and preg-abalin are considered to bind to the a2-8 subunit of voltage-gated calcium channels.83,8485 These channels are shown to be up-regulated in the spinal cord and dorsal root ganglia of a rat neuropathic pain model and are thought to play an important role in modulating neuropathic pain.86 Pregabalin has a greater efficacy and longer half-life than gabapentin necessitating a lower dose, thus reducing the side effects of gabapentin. It has been licensed by the FDA for treatment of pain associated with PHN and DPN. Clinical trials have shown this drug to be effective in dental pain,87 II PHN,88 II , 89 II and painful DPN.90 II , 91 II , 92 II , 93 II Topiramate, a newer anticonvulsant, acts on neuronal transmission in at least five ways, by modulating voltage-gated sodium ion channels, potentiating gamma-aminobutyric acid inhibition, blocking excitatory glutamate neurotransmission, modulating voltage-gated calcium ion channels, and by...
Classicially, three cardinal symptoms of TMD are mentioned (1) pain in the masticatory muscle and or joints (2) sounds from the TMJ (clicks, crepitation) and (3) changes in mandibular movements, usually as restriction in jaw-opening capacity. Pain is moderate to intense, can vary during the day, often with exacerbations during jaw-movements such as chewing and wide opening.18 The quality of myofascial TMD pain is a deep ache, tender and taut, which can be diffuse and difficult for the patient to pinpoint. The pain is often associated with referred pains to the TMJ, ear, temple, and teeth.19 TMJ pain is more localized around the TMJ with a sharp component and pain referrals to the ear region. Both the masticatory muscles and the TMJ will be painful on manual palpation. Clicking in the TMJ is not a problem in itself but can sometimes be unpleasant for the patient and cause irregularities during jaw-opening and closing. The disk in the TMJ can also cause a limitation in the maximal...
Cloves, also known as clove oil, have been used orally for stomach upset, for its antiplatelet effect, and as an expectorant. Cloves may also be used topically for pain relief from mouth and throat inflammation as well as athlete's foot. Its constituent, eugenol, has long been used topically for toothache, but the FDA has classified this drug into category III, meaning there is inadequate data to support efficacy (Covington et al. 1996). More evidence is necessary to rate clove for this purpose.
Paradoxically the human evidence for a pain-reducing effect with topical TCA application emerged before the animal work that verified the effect was published. Indeed, patients told clinicians that topical TCAs can reduce pain before clinicians hypothesized about this effect themselves. One remembers patients taking TCAs for a variety of uses telling us that when they had a toothache they held their TCA tablet against the offending tooth and that this reduced pain
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