Pain Management for the Periodontal Patient

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1 Pain Management for the Periodontal Patient

2 Pain Control During Periodontal Treatment

3 Methods of Pain Management General Anesthesia Nitrous Oxide Sedation Local Anesthesia Topical Anesthesia

4 Selection Criteria for Anesthesia Anesthesia needs - soft tissue or pulpal Location and size of treatment area Duration of periodontal procedure Epinephrine considerations Hemostasis needs - infiltration Contraindications/anesthetic sensitivities Patient management /comfort

5 Indications for Soft Tissue Topical Anesthesia Gingival/sulcular sensitivity Patient comfort and management Thoroughness/success of periodontal debridement Facilitation of probing and exploring

6 Soft Tissue Pain Management Topical gels Oraqix Rinses Sprays and aerosols

7 Topical Gel Anesthesia Guidelines Soft tissue anesthesia (2-3 mm of mucosal penetration) Higher concentration (20%Benzocaine) - limit amount and area of application Short duration of topical anesthesia (10-20 minutes) Dry area before application Application time - 1 to 2 minutes

8 ORAQIX New anesthetic option in periodontics Lidocaine /Prilocaine gel (2.5%/2.5%) Localized soft tissue anesthesia in periodontal debridement Cost per cartridge

9 Oraqix Protocol Deliver Oraqix with cannula to the gingival margin Wait for 30 seconds Apply Oraqix to depth of pocket Wait for 30 seconds Duration of anesthesia - approx 20 minutes May be reapplied

10 INDICATIONS FOR ORAQIX Need for localized soft tissue anesthesia Adjunct for local anesthesia given in other quadrants Need for needle free/less invasive anesthesia Patient management - dental anxiety issues

11 Sprays and Aerosols Cetacaine Soft tissue anesthetic spray difficult to control easy for patient to aspirate reduces gagging reflex

12 Liquid Topical Anesthetic Localized soft tissue anesthesia Apply with cotton applicator, probe, curet or syringe into pocket area

13 Liquid Topical Anesthesia Dyclone Swish for 30 seconds Expectorate All soft tissue affected

14 DENTINAL HYPERSENSITIVITY A short, sharp painful reaction that occurs when exposed dentin is exposed to a mechanical stimulus (toothbrush), thermal stimulus ( ice cream), or chemical stimulus (acidic fruits or candy).

15 Dentin Hypersensitivity 20% claim dentin hypersensitivity 60-90% in periodontal patients Up to 75% in whitening patients Common areas of sensitivity canines, first premolars, second premolars. Cold is the most common stimulus

16 Indications for Desensitizing Treatment Pain and sensitivity with hot and cold Sensitivity with brushing at home Pain and sensitivity during periodontal procedures Pain and sensititity after periodontal procedures

17 Effective Management of Dentin Hypersensitivity Are your teeth sensitive to hot or cold? Are your teeth sensitive when you brush? Are dental visits associated with sensitivity? How frequent is the sensitivity? How Long? Have you recently purchased or used whitening agents?

18 RISK FACTORS Wear, Abrasion, Attrition Abfraction / cervical stress lesion Erosion Gingival recession Periodontal therapy Patient Variability

19 Origins of Hypersensitivity Changes in temperature stimulate odontoblastic processes and result in painful stimulation. Changes in temperature create hydrodynamic forces within fluid filled dentinal tubules that stimulate odontoblastic processes.

20

21 TREATMENT Inform and educate patient Encourage meticulous plaque control Utilize professional products in the office Recommend desensitizing dentifrices for home use- Sensodyne, Colgate Sensitive, Prevident Sensitive, MI paste

22 MODES OF ACTION FOR DESENSITIZING AGENTS Nerve hyperpolarization - reduces nerve excitation Dentinal tubule occlusion

23 PRONAMEL (Sensodyne) High availability fluoride to enhance remineralization - ACP Low abrasivity and neutral ph 5% potassium nitrate for sensitivity protection Recommended for abrasion, erosion and tooth wear

24 MI Paste CCP-ACP - increases availability of calcium and phosphate Fluoride/Non-fluoride therapy Buffers acids Reduces sensitivity Application - cotton swab, prophy cup, or tray Contraindication - dairy allergies

25 Sensodyne Toothpaste 5% Potassium Nitrate to depolarize nerve endings Sensitivity reliief within 2 weeks Brush 2x daily

26 PROFESSIONAL PRODUCTS Fluorides -5% sodium Fl varnish and DentinBloc Calcium hydroxide Potassium oxalate -Protect/ThermaTrol Ferric oxalate - Sensodyne Sealant D/Sense2 - liquid desensitizer Gluma Desensitizer Glass ionomers, restorations and lasers

27 FLUORIDE VARNISHES DURAPHAT 5% sodium fl varnish DURASHIELD 5% sodium fl varnish OMNI VANISH 5% sodium fl varnish - white DURAFLOR 5% sodium fl varnish - slight tint PreviDent/Colgate 5% sodium fl varnish - transparent

28 5% Sodium Fluoride Varnish

29

30 5% NaF Varnish

31 GLUMA Desensitizer Reduces dentinal permeability/occludes the peripheral dentinal tubules Clean and rinse exposed cervical areas Apply GLUMA - avoid contact with mucous membranes Allow to set for seconds Dry with air again Rinse

32 In Office Procedures Therma-Trol Gel Potassium Oxalate Apply desensitizing gel to tooth for 2 minutes Rinse for 30 seconds

33

34 Colgate Sensitive Pro-Relief Contains calcium carbonate and arginine Plugs and seals open dentin tubules Can be used before or after periodontal procedures Applied with a prophy angle and cup

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