CHAPTER 5 Controlling Pain in Dentistry
Pain associated with the mouth has always been a subject of concern. Toothache is well known to be one of the most debilitating types of pain in the body. Because of this pain, dentists have been leaders in the development of both local and general anesthetic. Some persons believe it is necessary to feel oral pain during dental treatment. This incorrect belief has motivated many potential dental patients to avoid seeking proper periodic oral care. Is modern dentistry really that painful? What types of pain control concepts are available today? This chapter will inform you about the various methods dentists use to control pain, and it should convince you that most of today’s dentistry should be nearly painless.
Everybody has a pain response to trauma to the body. However, the degree of pain experienced from patient to patient varies enormously. It has been estimated that about half of the population could have a simple filling (restoration) accomplished without feeling any pain. The other half cannot tolerate the slight pain associated with this restorative procedure. You probably know if you have a high tolerance to pain, or a so-called high pain threshold. If so, you are fortunate, not only because dental procedures are easier but also because many slight abuses to your body are not a problem. If you have low tolerance to pain, or a “low pain threshold,” one of the following types of anesthetic is probably necessary for you to tolerate some dental procedures. Your dentist will quickly determine the level of your pain threshold, and he or she will plan your anesthesia needs accordingly.
Local anesthetics are the most commonly used type of pain control in dentistry (FIG. 5.1). Although you may think dentists use the old product Novocaine (Procaine), the most pop ular type of local anesthetic in dentistry is lidocaine hydrochloride 2%. Usually, this anesthetic has a slight amount of epinephrine (1:100,000) in it to constrict the blood vessels in the anesthetic site and prolong the duration of the anesthetic influence. This popular type of anesthetic is usually effective a few minutes after anesthetic delivery, and its duration is up to 3 hours. With very few exceptions, when this anesthetic is delivered adequately, the patient does not feel anything during treatment. Properly delivered local anesthetic should not be painful. The very small-diameter needles (FIG. 5.2), used carefully, and with preinjection topical numbing, provide simple, easy, painless anesthesia that dissipates soon after therapy is completed.