Tara Renton, Professor of Oral Surgery/Honorary Consultant, Faculty of Dentistry, Oral &
Craniofacial Sciences, King’s College London, explains for FGDP(UK) why a holistic approach and latest techniques should be priority
.

It’s every patient’s right to expect optimal pain management for routine elective
surgery. Most patients expect pain; three quarters experience pain, and a quarter
experience high-level pain during their appointment. This is far from ideal.
However, let us look at the confounding factors.

Dentistry is a profession predicated upon causing – and, or managing pain
in conscious patients, unlike most of our surgical colleagues whose patients are
anaesthestised.

The trigeminal nerve underpins our existence as it protects, sensorially, our senses including the organs that provide sight, smell, taste, hearing, speech
and meninges protecting our brain. Neurophsyiologically, our affective and
limbic systems in our brains are alerted before we set foot in the dental surgery
and the patient’s brain is anticipating and aligned for a pain experience.

Poorly managed pain, or severe pain perioperatively, is the predominant cause of
complaints in NHS dentistry, often leading to legal or General Dental Council scrutiny.
Whether the unexpected or persistent pain initiates the patient’s suspicions about
possible sub-optimal treatment, which then precipitates a complaint, is a possible
hypothesis. For now, however, focusing on managing the patient holistically, using
up to date pain management techniques, should be a priority.

Evidence highlights the risks of opiate and opioid dependence and mortality. Dentists
contribute significantly to many teenage patients being introduced to these drugs
for orthodontic and third molar extractions. It’s recognised that opiates and opioids
provide virtually no benefit for perioperative pain management compared with over the
counter analgesics. Patient management, optimal local anaesthetic techniques and
intelligent prescription of non-steroidal antiinflammatories and paracetamol are the
mainstay for odontogenic and surgical pain management.

It’s imperative that dental teams are familiar with current optimal peri-surgical
pain management to optimise patients’ experience and minimise complaints or
other professional challenges.

Read more…

PDJ is the quarterly peer-reviewed journal produced by the Faculty of General Dental Practice (UK), and provided as a benefit of membership. Three issues of PDJ in each volume are themed on a topic of interest and relevance to the primary care dental team, led by an invited Guest Editor who is a renowned expert in the field, with one ‘general issue’ per volume covering a wide range of topics.

Translating current evidence into best practice, PDJ is an indispensable and practical resource for the entire dental team, with each edition offering a valuable update on an area of practice within the context of general dental care.