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7.1 INTRODUCTION

The effective management of intraoperative and postoperative pain is an essential part of implant dentistry [1]. There is a wide range of anaesthetic and analgesic agents available to minimise the discomfort that the patient may experience. A thorough understanding of these medicines is essential, and the practitioner must use the appropriate regime and technique for each individual patient. This involves an accurate and detailed history, consideration of maximum doses and a knowledge of the level of pain control required.

7.2 ACUTE DENTAL PAIN

In most patients with acute dental pain, the pain will be related to the teeth and jaws, but myocardial infarction can present in this way on rare occasions (Figure 7.1).

When managing acute pain, a full discussion and investigation are undertaken and the aetiology of the pain is determined. There is a clear diagnosis. The cause of the pain is addressed and appropriate analgesics are prescribed in the context of the individual needs of the patient and the history (B). It is prudent to remember that patients suffering from pain may self‐medicate and indeed exceed the recommended dose of analgesics.

7.3 PREOPERATIVE PROPHYLAXIS

Studies investigating prophylactic or single‐dose analgesics prior to surgery show inconclusive results. Ibuprofen, paracetamol (with or without codeine) and diclofenac prophylactically can reduce perceived postoperative pain.

When considering prescribing preoperative analgesics, an excellent knowledge of the scientific basis and literature surrounding preoperative analgesics is required. Each patient is assessed on their individual needs and, if appropriate, preoperative analgesics are recommended/prescribed (B).

7.4 SURGICAL ANAESTHESIA

Anaesthesia is defined as a loss of sensation in a circumscribed area of the body by depression of excitation in nerve endings, or an inhibition of the conduction process in peripheral nerves [2]. The use of local anaesthesia should be carefully considered in the context of the medical history of the patient. Drug interactions may occur with either local anaesthetics or vasoconstrictors.