Management Of Acute Dental Pain Research Articles

Patient Values and Preferences for Managing Acute Dental Pain Elicited through Online Deliberation.

Patient values and preferences (PVP) are among multiple sources of information panelists synthesize when developing clinical practice guidelines (CPG). Patient and public involvement (PPI) can be critical for learning PVP; however, the methodology for engaging patients in CPG development is lacking. Deliberative engagement is effective for obtaining public views on complex topics that require people to consider ethics, values, and competing perspectives. Elicit comprehensive understanding of PVP concerning oral analgesics for managing acute dental pain consecutive to toothache and simple and surgical dental extractions, with consideration of associated outcomes, both desirable and undesirable. Multistage engagement involving 2 electronic surveys and a 90-min online small group deliberative engagement. Adults who have experienced acute dental pain deliberated about 3 hypothetical scenarios stratified according to expected pain intensity, completed a postdeliberation survey, and validated a PVP statement developed by researchers based on review of qualitative data from deliberations and quantitative data from surveys. Participants affirmed the PVP statement reflected their small group deliberations and their individual views. Most indicated that pain relief is critical to deciding which pain relief medicine they would want regardless of expected pain level. Most also identify as critical concerns about substance abuse or misuse, although many believe it unlikely that they will experience these outcomes over the brief prescription timeframe for acute dental pain. Participants identified agency in decision-making, consultation including "better communication" of options, and treatment actions tailored to life circumstances as key values. Participants preferred nonprescription and nonopioid pain relief options. As expected pain levels increased, more participants expressed willingness to accept opioids, but more also mentioned rescue analgesia as a third outcome critical to decision-making. Online deliberative method provided opportunities for obtaining informed perspectives. Guideline developers and policymakers may find online deliberations useful for eliciting PVP related to health outcomes. Study results informed the US Food and Drug Administration-funded clinical practice guideline on the management of acute dental pain. Findings may be a resource for clinicians in decision-making conversations with patients regarding expectations for pain relief and positive and negative outcomes of differing pain relief medications. Further research should pursue applicability of online deliberative engagement as a method to elicit patient values and preferences.

An overview of assessment and management of acute dental pain.

Dental care practitioners are often the first port of call for patients presenting with acute dental pain. Due to the increasing backlog of patients in the UK resulting from the COVID-19 pandemic, it is expected that an increasing number of patients will present to dental care practitioners with acute dental problems. This article aims to provide an overview of common presentations of acute dental pain, the importance of thorough assessment and accurate diagnosis, and the management of such conditions.

A qualitative exploration of dentists' opioid prescribing decisions within U.S. veterans affairs facilities.

The U.S. Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States and provides dental care to approximately one-half million veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. Although opioid prescribing by VA dentists has decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that affect opioid decision making for management of acute dental pain among VA dentists. Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semistructured guide designed around the Capability (C), Opportunity (O), Motivation (M), and Behaviour (B) model. Audio recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (eg, electronic medical records), clinical judgement (eg, evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. The results can offer intervention targets for continued opioid risk mitigation efforts.

Management of Acute Dental Pain and Oral Health Challenges among Pregnant Women in Pakistan

Introduction: Pregnancy is a physiological state that causes a variety of changes in the mouth cavity, as well as other physiological changes throughout the female body. Some of the modifications typically seen in pregnant women include gingival hyperplasia, gingivitis, pyogenic granulomas, and other salivary alterations.
 Objectives of the Study: The main objective of our study is to find the management of acute dental pain oral health challenges faced by the pregnant women in Pakistan. Because like other systems of the body oral system also face many problems during pregnancy in women.
 Methodology of the Study: A cross-sectional survey of pregnant women attending the Punjab Dental Hospital, Lahore during 2020 to 2021. A convenience sample of 100 pregnant women was invited to participate by a dental assistant.
 Results: We select 100 patients for our study and these are pregnant women who completed the survey. The mean age of the participants ranged from 16 to 40 years. More than half (59.3%) reported dental problems during pregnancy, less than a third (30.5%) saw a dentist in the last six months, only 10% had received any information about perinatal oral health and many (>50%) were unaware of the potential impact of poor maternal oral health on pregnancy and infant outcomes.
 Conclusion: The present study indicates that the oral health status is not appropriate among the pregnant women. On the other hand, the high prevalence of dental plaque, poor periodontal condition and unsatisfied treatment require a preventive population based strategy with an emphasis on the improvement of the oral self-care for the pregnant women.

Pharmacological Management of Acute Endodontic Pain.

Pain associated with infections of the tooth pulp and periapical tissues is intense and often the most common reason for patients seeking emergency dental care. Effective management of acute dental pain requires a deep understanding of pain mechanisms, which enables accurate diagnosis and definitive treatment. While drugs are only used as an adjunct to definitive dental treatment, a thorough understanding of their mechanism of action and effectiveness enables clinicians to effectively control intra-operative and post-operative pain and prevent persistent pain. This review describes how pain is detected, processed, and perceived. It also provides information on evidence-based strategies on the use of different classes of drugs to effectively manage endodontic pain.

Management of Acute Dental Pain during Pregnancy - A knowledge assessment of Dentists at University Hospital

Aim: The purpose of the study was to explore the knowledge of the dentists regarding effective acute dental pain management among pregnant women. Methodology: Descriptive cross-sectional study design was conducted in the Operative Department, Dental Hospital at The University of Lahore. Sample size was 378 as in a Pakistani study. Non-probability convenient sampling technique was used to collect data. As descriptive statistics and data was analysed Results: Among 378 dentists, 122 (32.3%) had excellent knowledge and 143(37.8%) had good knowledge while 113 (29.9%) dentists had poor knowledge regarding management of acute dental pain during pregnancy Conclusion: Majority of the dentists reported good knowledge to deal pregnant patients with regards to procedure preferences. Keywords: Pregnant patients, Text books, Trimester, Dental pain management

An investigation into possible factors that may impact on the potential for inappropriate prescriptions of antibiotics: a survey of general dental practitioners' approach to treating adults with acute dental pain.

Objective To investigate factors that might influence inappropriate prescriptions of antibiotics (ABs) by UK-based general dental practitioners (GDPs) in their management of acute dental pain in adults in primary dental care.Methods A questionnaire was circulated via social media to UK-based GDPs. The questionnaire examined GDPs' likelihood of issuing an inappropriate AB in two hypothetical clinical scenarios.Results A total of 205 questionnaires were completed, of which 198 were included for analysis. The resulting data were analysed to try and identify factors that correlated with an increased likelihood of an inappropriate AB prescription being issued for each clinical scenario. The results suggested the following factors as being associated with a statistically greater chance of the survey respondent issuing an inappropriate AB prescription: no postgraduate qualification; received their primary dental qualification from a non-UK university; scheduled appointments of less than 20 minutes; and low confidence in their ability to provide adequate local anaesthesia for the patients in the clinical scenario.Conclusions Four factors were shown to be associated with dentists' stated intention to prescribe ABs for acute dental pain, not in accordance with guidance. These results should guide further research to understand the significance of appropriate AB prescribing on the quality of urgent dental care. While the total number of respondents was too low to enable the results to be generalised, it is hoped that the results may help guide future research. Further studies could focus on these factors to understand more about their impact on the urgent care of adult patients in pain. The impact of the restrictions caused by the response to COVID-19 needs to be considered.

Codeine for Acute Dental Pain and Acute Pain Related to Dental Procedures


 Two overviews of systematic reviews, 4 systematic reviews, and 9 randomized controlled trials were identified comparing codeine or codeine combination drugs with placebo and/or other drugs in the management of acute dental pain.
 As compared to placebo, codeine was generally shown to offer a benefit to patients experiencing acute dental pain.
 When compared to other drugs and/or drug combinations — particularly those that were acetaminophen- or ibuprofen-based — codeine generally was not found to be as clinically effective for the management of acute dental pain, with the potential exception of tooth sensitivity following dental bleaching, where 1 study reported that acetaminophen plus codeine was statistically significantly superior to ibuprofen or placebo.
 Increased adverse events were observed with codeine-containing drugs as compared to other drugs and/or placebo.
 Studies included in this review demonstrated both strengths and limitations, some of which limit the extent to which the findings from these studies were relevant to this report and/or can be generalized.

Endodontic Management of Acute Dental Pain Among Pregnant Patients

OBJECTIVE: The purpose of this study is to reinforce the safety of non-surgical endodontic treatment in the management of acute dental pain of pulpal origin in pregnant patients in all trimesters. METHODOLOGY: The study was conducted amongst pregnant females with acute dental pain. Pain of endodontic origin in 273 pregnant patients was managed by performing non-surgical root canal treatment. Percentages were calculated as descriptive statistics to have a comparison of preferred treatment by dentists for acute pain management during pregnancy. One Way ANOVA was used to explore the difference between treatment selection plans. RESULTS: From the total sample of 273 participants, there was no significant difference found between the selection of endodontic treatment and Trimesters (F (2,270) = .79, p=.45) same results were obtained for the analgesics prescription during pregnancy and the trimesters during pregnancy (F (2,270) = 1.41, p=.24). On the other hand, the difference between the prescription of antibiotics during 1st, 2nd and 3rd trimesters was found which was statistically significant (F (2,270) = 12.38, p> .001). Endodontic treatment was completed on 251 (91.6%) pregnant patients to relieve the acute dental pain whereas only 22 (8.4%) patients did not undergo endodontic treatment in pregnancy. Among the cases who had endodontic treatment, 75.4% of cases were dealt with in the second trimester of pregnancy. The recommendation of antibiotics was less. In the entire data, antibiotic prescription was seen in the second trimester of pregnancy, whereas, overall, antibiotic prescription was at minimal level. Analgesic prescription was found to be (44.1%) in practice among pregnant participants during the treatment. CONCLUSION: Non-Surgical Endodontic Treatment is a safe and reliable treatment option for the management of restorable teeth with acute pain of pulpal origin in pregnant patients. Dentists should not be reluctant in prompt invasive dental management in these patients if indicated. KEYWORDS: pregnancy, pain, dental treatment, endodontic treatment HOW TO CITE: Khan SA, Hassan AU, Iqbal Z, Hassan M. Endodontic management of acute dental pain among pregnant patients. J Pak Dent Assoc 2021;30(1):7-11.

Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews

BackgroundEffective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of this study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews. Types of Studies ReviewedAn overview of systematic reviews was conducted to evaluate the efficacy or reported adverse events associated with orally administered medication or medication combinations for relief of acute pain. Reviews were inclusive of all age populations but were limited to those that evaluated medication and medication combinations marketed in the United States and had moderate or high methodological quality according to the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool. ResultsFive reviews were found eligible for inclusion. The data identified combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations. Practical ImplicationsThe best available data suggested that the use of nonsteroidal medications, with or without acetaminophen, offered the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events.

Acupuncture in the Management of Acute Dental Pain

Acute dental pain is the main reason for seeking dental services to provide urgent dental care; there is consensus about the use of alternative therapies, such as acupuncture, to control dental pain in pre-dental care. This study aimed to evaluate the use of acupuncture in reducing the intensity of acute dental pain in pre-dental care in patients waiting for emergency dental care, and was conducted at the After-Hours Emergency Dental Clinic of Piracicaba Dental School, and at the Emergency Center Dental Specialties I in Piracicaba, São Paulo, Brazil. The sample consisted of 120 patients. The Visual Analog Scale (VAS) was used to measure pain intensity. All patients underwent one session of acupuncture; the points LI4, ST44 and CV23 were selected and were used alone or in combinations. Reduction in pain was observed in 120 patients (mean initial VAS = 6.558 ± 1.886, p < 0; mean final VAS = 0.962 ± 2.163, p < 0.00001). The results of this study indicate that acupuncture analgesia could be a technical adjunct to pain control in patients with acute dental pain, contributing to the restoration of health with social benefit.

Pain management: Part 1: Managing acute and postoperative dental pain.

Safe and effective management of acute dental pain can be accomplished with nonopioid and opioid analgesics. To formulate regimens properly, it is essential to appreciate basic pharmacological principles and appropriate dosage strategies for each of the available analgesic classes. This article will review the basic pharmacology of analgesic drug classes, including their relative efficacy for dental pain, and will suggest appropriate regimens based on pain intensity. Management of chronic pain will be addressed in the second part of this series.

Teaching Dental Pain With and Without Underlying Oral Physiology: Learning Implications

This study investigated whether teaching undergraduate dental students the diagnosis and management of acute dental pain alongside the underpinning oral physiology helped them to understand the topic better than teaching them acute dental pain as a separate entity. Each of three clinical years of dental students at the same dental school was taught in two groups. Each group was taught the signs/symptoms of five acute dental pain conditions by the same member of the staff. However, the teaching for one group of students in each year reminded the students about the physiology that underpinned the clinical symptoms. One week later, the students completed an open-ended questionnaire that required them to list signs/symptoms of the five dental pain conditions. For each year of dental students that was examined, the mean student marks were significantly higher (p<0.05) for those who were taught dental pain and the underlying physiology compared with students who were only taught dental pain as a stand-alone subject. This suggests that integrating biomedical science and clinical teaching is beneficial.

The management of acute dental pain in the recovering alcoholic.

Although there have been many advances in our understanding of the neurophysiology of pain, the management of acute pain continues to be a challenge. When the need arises to provide adequate and effective pain management for the recovering alcoholic, the problem becomes much more complex. The clinician must provide the patient with adequate analgesia without causing a relapse. In the US, 6% to 10% of the population has attended Alcoholics Anonymous at some point, increasing the likelihood of the clinician being faced with the need to manage acute pain in a recovering alcoholic. The purpose of this article is to suggest guidelines for the management of acute dental pain in the recovering alcoholic based on current principles of acute pain management and for the treatment of pain in addicted patients.

Management of acute dental pain: a practical approach for primary health care providers

Reproduced with permission from Australian Prescriber The document attached has been archived with permission from the publisher/copyright holder

The efficacy of management of acute dental pain.

The effectiveness of pain relieving treatments given for acute dental pain has been evaluated after 24 hours in 172 patients who presented to a dental hospital emergency department. Patients were contacted by telephone the day after attendance and graded their pain on a scale from 1 (no pain) to 5 (pain much worse). The mean pain scores for each diagnosis of cause of pain were calculated and related to the treatment given. Some 76% of patients were in pain due to the ravages of dental caries of periodontal disease. Overall, 87% received marked or total pain relief and this appeared to depend upon decompression of inflamed tissue. Oral administration of antimicrobial drugs alone produced little or no pain relief within 24 hours and anti-inflammatory analgesics offer poor pain control in these circumstances.