13: Pain and Anxiety Control

CHAPTER 13 Pain and Anxiety Control

Precautions in use of drugs for anxiety and pain control

It is important always to take a full medical and drug history, since the medical status or medications a person may already be taking can influence the choice of drugs (see Chapters 2 and 6). Certain drugs may need to be avoided or doses reduced in specific conditions. It is particularly important to ensure there is no history of allergy or untoward effect from the drug being considered.

The clinician can check drug doses, contraindications, interactions and adverse reactions in the British National Formulary (BNF) or the special dental version called the Dental Practitioners’ Formulary (DPF).

If aspirin or paracetamol is indicated, it should be given at least 30 minutes before food, since the absorption of these drugs is otherwise delayed.

Anaesthesia and sedation


There are two types of anaesthetic used in medicine:

Local anaesthesia (or local analgesia) is required for many dental procedures. Thousands of patients are treated successfully using LA, without any problem. Some people, however, cannot accept injections and others have a pronounced gag reflex or fear of ‘the drill’. In these patients LA cannot be used or will not help. Such patients may benefit from using CS.

CS can be induced through several routes:

In extreme cases where the patient is unable to co-operate, or in major procedures such as maxillofacial surgery, GA is indicated. However, GA can be potentially dangerous and life-threatening. Therefore GA must be given in a hospital with critical care facilities.

Local anaesthesia

Local anaesthesia is generally a very safe procedure. It is made safer by ensuring that:

Types of Local Anaesthesia

Injected local anaesthesia

The preferred method of dental and oral pain control is often injected LA, since it is very safe and is adequate for most procedures. When LA is injected it blocks transmission in the nerve that is in that area. This allows patients to undergo procedures without pain. It is also used in most cases where CS or GA are used. LA is given with an aspirating syringe to prevent the accidental injection of the LA agent into a vein or artery, which could cause the patient to collapse. Disposable needles are used (and never re-used; Figure 13.1) to avoid any risk of transmitting infections. Needlestick injuries must be avoided (see Subchapter 1.2).

Types of Injection

There are several ways in which LA can be given by injection. The most common techniques used in dentistry are: infiltration, regional block and intraligamentary injection. Following infiltration and regional block anaesthesia there is not much systemic absorption of the drug, that is, it does not get distributed in the entire body.

In addition:

Local Anaesthetic Solutions

The main LA solution that is used in the dental workplace is lidocaine (formerly called lignocaine). It belongs to a class of drugs called amides. Other commonly used amides for dental procedures are prilocaine, articaine and mepivacaine. See also Table 13.1.

The majority of LA dental cartridges also contain a vasoconstrictor. The vasoconstrictor used in dental LA is either adrenaline (epinephrine) or felypressin (Table 13.1).

Dental Local Anaesthetic Syringes

A dental syringe (Figures 13.1 and 13.2) is a hand-held device that carries the LA cartridge for injection of LA. The major problem with most syringes is that the needle has to be removed from the syringe prior to sterilisation. This puts the operator at increased risk of injury (sharps or needlestick injury) during the dismantling process. The rising awareness of infection control is also putting increased pressure on manufacturers to introduce fully disposable instruments. These issues have led to the development of dental safety syringes. The types of safety systems include:

With regard to loading a cartridge, syringes may be:

Jan 8, 2015 | Posted by in Dental Nursing and Assisting | Comments Off on 13: Pain and Anxiety Control
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