Oral analgesics for acute dental pain

Acute pain is the most common complaint that causes patients to seek help from healthcare professionals. Pain management remains an important consideration in dental care and patient management. Although utilized for acute pain control, analgesics provide significant anti-inflammatory effects. Anti-inflammatory analgesics are available both over-the-counter (OTC) and by prescription. Since analgesics are widely used in dentistry and by patients for other medical indications, the dentist should be knowledgeable in their pharmacology.

Pain, as defined by the International Association for the Study of Pain, is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” Pain is not a single entity; it is part of the entire inflammatory process and one of the clinical signs of inflammation. Pain can be described as (1) acute, (2) chronic and associated with malignant disease, or (3) chronic and not associated with malignant disease. The duration of acute pain is usually hours to days, while chronic pain can last months to years and have associated problems of depression and anxiety.

Oral pain is associated with pulpitis, periodontitis, pericoronitis, abscesses (endodontic/periodontal), trauma, and other conditions including temporomandibular disorders (TMDs) and masticatory muscle disorders. Dental procedures also can have pain as a sequela with more invasive procedures increasing this likelihood. Pain is provoked when a variety of inflammatory mediators are released into the tissues. These pain-inducing substances can be produced and released from cell membranes by trauma (eg, mechanical trauma to the soft tissues and bone during periodontal surgery), infection, and allergenic reactions. Therefore, part of the successful management of pain requires blocking or managing the development of inflammation.

The majority of dental pain is an acute response to inflammation. The acute pain associated with dental trauma, infection, or surgery is usually managed pharmacologically. The key to pharmacologically managing pain is to provide a sufficient dose of a particular drug to minimize pain onset and give the patient comfort. The drug should be administered frequently to prevent the pain from becoming severe. The most effective way to maintain analgesia is to administer doses on a regularly scheduled basis for a specified period after the trauma. For example, after periodontal surgery, inflammation and pain usually peak 48 hours later. Thus, postoperative analgesic medication can be administered on a regular schedule, depending on the half-life of the drug (eg, every 4 hours), for 48 hours, then given as necessary.

Notes:

management – лікування

mediator -1) посередник 2) (нейро)медіатор

pericoronitis - перикороніт (запалення м’яких тканин навколо коронки зуба)

sequela – наслідок, остаточне явище, ускладнення хвороби

half-life -1) період напіврозпаду 2) період напіввиведення