this presentation just to evulate the D/D of Facial Pain and uses of Opiods analgesics in dentistry.

2. Dr.Muhammad Athar khan BDS,FCPS
Assisstant Professor
Bakhatwar Amin Medical & Dental
College,Multan.

4.  Pain is an unpleasant sensational
experience by a Noxious stimulus.
 Pain is the result of an electrical
signal being sent from the nerves
to the brain.
 Physical & Emotional
 It can range from mild, localized
discomfort to agony.
 The physical part of pain results
from nerve stimulation.

5.  Transduction
 Transmission
 Modulation
 Perception

7.  Site of pain
 ‡type of pain
 frequency and duration
 Onset
 Exacerbation and remission (for example the
response to heat or cold)
 Severity
 Area of radiation.
 Current Medications
 History of Allergies
 Associated pathology and
 referred pain should also be considered.

8. Local (Dental)
I. Pulpitis,
II. Dentine Hypersensitivity,
III. Periapical periodontitis,
IV. Cracked Tooth syndrome
Gingiva
 Gingivitis
 Primary herpetic
Gingivostomatitis,
 ANUG,
 Desquamative Gingivitis)
 Mucosal
 Aphthous Ulcers
 Salivary
Glands(sialadenitis)
 TMPDS
 Sinusitis

9.  Trigeminal Neuralgia
 Glossophyarngeal
Neuralgia
 Ramsay Hunt Syndrome
 Postherpetic Neuralgia
Psychogenic
• Atypical Facial Pain
• Atypical Odontalgia
• Burning Mouth Syndrome
Referred Pain
• Cardiac pain
• GIT
Vascular
 Giant cell arteritis
 Migraine
 Cluster Headache
 Tension Type Headache
 Chronic Proxysmal
haemicrania

13. Analgesic, or painkiller, is any member of the
group of drugs used to achieve analgesia —
relief from pain.
 Major classes of Analgesic Drugs include:
 Opioids
 NSAIDs

14. Narcotic analgesics are drugs that
relieve pain, by binding to opioids
receptors, which are present in the
central and peripheral nervous
system, relieve severe Pain and
induce a state of unconsciousness.

16.  All opioid receptors are G-protein coupled
receptors and inhibit adenylate cyclase.
 Postsynaptic hyperpolarization (increasing K+
efflux)
 Reducing presynaptic Ca++ influx
 thus inhibits neuronal activity.

17. Surprisingly, people younger than 21 years
received more than 11% of dentist-prescribed
opioids.

18. Natural Compounds:
I. Morphine
II. Codeine
III. Papaverine
Semi-Synthetic:
i. Diacetylmorphine
(Heroin)
ii. benzylmorphine
iii. ethylmorphine
Synthetic Derivatives
 Fentanyl
 Pethidine
 Methadone
 Tramadol
 Propoxyphene

19. There are of 4 types:
 μ receptor
 σ receptor
 δ receptor
 Κ receptor

20. μ-Receptors are thought to be responsible for
most of the analgesic effects of opioids, and for
some major unwanted effects. Most of the
analgesic opioids are μ-receptor agonists.

21.  Severe,sharp,visceral Pain
1. Myocardial Infarction
2. Euphoria and sedation
3. Severe Burns
4. Cancer Pain
5. Fracture of Bones
6. Acute Pulmonary oedema
7. Pupitis
8. Obs & Gynae( labour pain)
9. Premedication in anesthesia
10. Cough suppersant
11. Diarrheoa(Reduced gastrointestinal motility,
causing constipation )

22.  Morphine is the major analgesic drug &
prototype strong agonist.
 It is given by
 injection (intravenous or intramuscular) or
 Mouth, often as slow-release tablets.
Disadvantage:
 Drug of addiction due to euphoric effect
 Over dose causes poisoning i.e. Coma and
Respiratory Depression.
 Cause dryness of mouth, mental clouding,
vomiting, headache, fatigue, constipation etc.

25. Naloxone
 Naloxone was the first pure opioid
antagonist, with affinity for all three opioid
receptors.
 The main clinical uses of naloxone
 Treat respiratory depression caused by
opiate over dosage.
 It is usually given intravenously, and its
effects are produced immediately.