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Control of pain in operative dentistry

Contents
Definition History of pain in dentistry Basic concepts
1. Pain reaction 2. Pain thrershold

3. Pain perception

Anatomical basis of dental pain Control of pain Methods of pain control

Definition of pain Pain is defined as an unpleasant sensational experience initiated by noxious stimulus & transmitted over a specialized neural network to cns where it is interpreted as such. History of pain in dentistry Most patients seek dental treatment either for the relief of pain or in the hope of avoiding it at a later date.pain may be regarded as raison d^etre of the dental profession. Basic concepts Pain is almost always compounded with other sensations & attitudes & reactions to it may be affected by both emotional & cultural factors.to simplify it is convenient to divide pain into components pain perception pain reaction pain threshold pain perception the skin & mucous membrane are provided with numerous nerve end organs for the

perception of touch temperature & pain stimuli. The end organs are free non medullated fibres .the application of any stimulus may produce an impulse which is self propagating & of uniform intensity. This is because each fibre obeys all or none law i.e. if a stimulus is sufficient to produce an impulse at all the resultant impulse is of a uniform pattern & cannot be magnified .the severity of pain perceived by the subject is governed by many factors one of which is the number of nerve fibres that are activated . pain reactionis term used to describe the integration & appreciation of pain within the cns which occurs in the cortex & posterior thalamus. This is variable factor which accounts for clinical observation that intensity of pain & the patients response to it may vary not only between individual but also from time to time in same individual. Pain threshold is a term employed to when variable response to pain is discussed. A patient is said to have

high threshold when he exhibits little or no reaction to painful stimulus.some individual react violently to an identical or even lesser stimulus- low threshold.pain threshold also varies between same individual at different times.factors determining level of tolerance are Psychological make up of patient Fear & apprehension of dental treatment Fatigue Age of the patient. Anatomical basis of dental pain impulses originating in the nerve endings of dental pulp & the supporting structures of the teeth are conveyed to the cns by 2nd & 3rd divisions of trigeminal nervefrom cell bodies in gasserion ganglion these neural pathways pass to sensory nucleus of trigeminal nerve in medulla oblongata & extends to the level of 2nd c segment of spinal cord.

Nerve fibres of dentin pulp complex

The nerve supply of the dentin-pulp complex is mainly made up of A fibres (both delta and beta) and C fibres. They are classified according to their diameter and their conduction velocity. The A fibres are mainly stimulated by an application of cold, producing sharp pain, whereas stimulation of the C fibres produces a dull aching pain. Because of their location and arrangement, the C fibres are responsible for referred pain

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