regarding the pain perception and by which mechanism. theories regarding pain

2. INTRODUCTION

3. CONTENTS











DEFINITION
HISTORY OF PAIN
SIGNIFICANCE OF PAIN
PAIN RECEPTORS
PAIN PERCEPTION
PAIN TRANSMISSION
 PAIN FIBRES
 PAIN PATHWAYS
 PAIN CENTRES IN THE BRAIN
TYPES OF PAIN
THEORIES OF PAIN
METHODS TO CONTROL PAIN
 LOCAL ANESTHESIA
 PAIN KILLERS (NSAIDS, OPIOIDS)
 ACUPUNCTURE
FUTURE TRENDS IN PAIN CONTROL
ELECTRONIC DENTAL ANESTHESIA, WAND
CONCLUSION

4. DEFINITION

5. History of pain
The Babylonian concept
 Chinese
 Homer
 The Bible- anguish
 Hebrews- grief and sorrow
 Plato- soul
 Hippocrates- humors


6. Significance

SHORT LATENCY

LONG LATENCY

7. PAIN RECEPTORS

SOMATIC NOCIRECEPTORS

VISCERAL NOCICEPTORS

8. PAIN PERCEPTION
SUBSTANCES RELEASED
 SUBSTANCE-P
 SERATONIN
 HISTAMIINE
 BRADYKININ-prostaglandins to act

9. PAIN TRANSMISSION
PAIN FIBRES
 PAIN PATHWAYS
1. First order neurons
2. Second order neurons
3. Third order neurons
 PAIN CENTRES


10. PAIN TRANSMISSION

PAIN FIBRES
A-delta fibres (immediate pain)
C fibres (diffuse pain)

11. PAIN PATHWAYS

Trigeminal nerve
Semilunar ganglion (g.g)
Sensory root
Pons
Sensory root
Ascending fibres
Tactile sensibility
Descending fibres
Pain and Temperature

12. PAIN PATHWAYS
Each end organ has its pathway into CNS
The pain pathway consists of
First
order neurons
Second
Third
order neurons
order neurons

13. First order neurons

Cells of posterior nerve root ganglia

A- delta fibres- marginal cells in
posterior gray horn

C- fibres- Substantia gelatinosa in
posterior gray horn

14. Second order neurons

The marginal cells and the cells of
Substantia gelatinosa form the second
order neurons

15. Third order neurons

Neurons of Thalamic nucleus, reticular
formation, tectum and grey matter
around aqueduct of sylvius

These neuron axons reach sensory area
of cerebral cortex

16. Classification

Based on duration
Acute and chronic

Based on etiology
Inflammatory, Nociceptive and
Neuropathic pain

Atypical facial pain

Refered pain

17. Types of DENTAL pain

Arising from

Pulp

Peri radicular region

Exposed dentin

Cracked tooth syndrome

18. Classification of Oro facial
pain
Physical Conditions
a. Somatic pain
 Superficial Somatic pain
 Cutaneous pain
 Mucogingival pain
 Deep Somatic pain
 Musculoskeletal pain
 TM Joint pain
 Periodontal Pain
 Osseous and periosteal pain
b. Visceral pain

○
○
○
Pulpal dental pain
Vascular pain
Neurovascular pain
c. Neuropathic pain
○
○
Episodic pain
Continuous

19. THEORIES TO EXPLAIN
PAIN
SPECIFICITY THEORY
Descartes-1644
Muller-19th century
Von frey-1895
 PATTERN THEORY
Gold Scheider-1894
 GATE CONTROL THEORY


20. GATE CONTROL THEORY

GATE input

GATE output

21. Factors that OPEN the gate

Physical (injury)

Emotional (depression)

Behavioural (focusing on pain)

22. Factors that CLOSE the
gate

Physical (medication)

Emotional (happiness, relaxation)

Behavioural (distraction)

23. Limitations

No one has located gate mechanism

Assumption of organic basis

Integration and interaction of mind and
body

24. DIAGNOSIS
Location
 Onset of the pain
 Duration
 Behaviour


25. Pain assessment tools
Visual Analog scale
 Mc Gill Questionnaire
 Numeric Pain Intensity Scale
 Simple Descriptive Pain Intensity Scale
 Graphic Rating Scale
 Verbal Rating scale
 Pain Faces Scale
 MPI Scale


26. Visual analog scale(VAS)

27. MANAGEMENT OF PAIN
LOCAL ANESTHETICS
 ANALGESICS
 NSAIDS
 OPOIDS
 CONSCIOUS SEDATION


28. ACUPUNCTURE
From Latin – acus=needle and
pungere=prick
 Acupuncture points


29. FUTURE TRENDS IN PAIN
CONTROL

ELECTRONIC DENTAL ANESTHESIA

AUDIO ANALGESIA

WAND

30. ELECTRONIC DENTAL
ANESTHESIA
In 46 AD, Scribonius Largus to emperor
Claudius used torpedo fish to relieve
pain
 In 1883 Erb wrote “electric current is one
of the brilliant remedies for neuralgic
pain”
 MECHANISM OF ACTION


31. ELECTRONIC DENTAL
ANESTHESIA

Indications

Contra indications

Advantages

Disadvantages

33. AUDIO ANALGESIA

Described by Gardner and Licklider (1959)

This method uses loud sounds to produce
insensitivity to pain in some patients.

34. WAND

35. CONCLUSION

36. REFERENCES







Carranza, Newman, Takei, Klokkevold:
Carranza’s clinical periodontology, 10th Ed.
Elsevier.
Monheims –local anesthesia and pain control
in dental practice, 7th Ed, Pg 7 & 21, CBS
Bell’s- Textbook of Orofacial pain
Guyton- Textbook of medical Physiology, 10th
Ed. pg 553. Saunders
Indu khurana- Textbook of Human Physiology
Malamed- Handbook of Local Anesthesia, 5th
Ed. Pg 352-4, Mosby
Shafers- Textbook of Oral Pathology

37. THANK YOU…