This document discusses pain pathways related to the orofacial region and periodontium. It describes how pain signals are transmitted from nociceptors through three orders of neurons to the brain. First order neurons carry signals from nociceptors to the spinal cord, second order neurons transmit signals to the thalamus, and third order neurons relay signals to the sensory cortex. The trigeminal nerve provides innervation and sensory function to the periodontium. Understanding pain pathways and sources is important for properly diagnosing and treating orofacial pain.
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Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Endo perio lesions /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This brief lecture talk about very important topic in endodontic diagnosis and it is the Endodontic-Periodontal Relationship. It's directed to the level of mind of undergraduate students. I tried to keep it as simple and coherent as possible
Chronic periodontitis is an infectious disease resulting in inflammation with in supporting tissues of the teeth, progressive attachment loss and bone loss. With all emerging technologies, a successful diagnosis and treatment will only be achieved through open sharing of ideas, research findings and thorough testing .
Pulp vitality test is the one of the diagnosing method in DENTISTRY....this presentation deals about the best methods for diagnosting the vitality of the tooth.
Diagnosis in endodontics /certified fixed orthodontic courses by Indian dent...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Endo perio lesions /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Definition n classification •Pathophysiologyof pain. •Physiological Effects of pain. •Pharmacological & non-pharmacological methods of analgesia. •Principles of pain management.METHODS OF CONTROLLING METHODS OF CONTROLLING
Non-pharmacological Preoperative counseling TENS Acupuncture
Pharmacological Opioids •Im •IV infusion •IV PCA Local anaesthetics: •Local Infiltration •Nerve Blocks •Epidural Blocks NSAIDS •IM •IV infusion •IV PCA
NON-PHARMACOLOGICAL METHODS PRE-OP COUNSELLING: Well informed patients about: •Nature of operation •Nature of post operative pain •Methods of analgesia available
Cope better with Post –op Pain
NON-PHARMACOLOGICAL METHODS TENS (Trans Cutaneous electric nerve stimulation)
Stimulates afferent myelinated (A-beta) nerve fibers at 70hz
Inhibitory circuits within sp cord activated
Nerve impulse transmission reduced
Maximum benefit in neurogenic pain
PHARMACOLOGICAL METHODS OPIODS •Activate opiodreceptors within the CNS •Reduce transmission of nerve impulses by modulation in the dorsal horn
PHARMACOLOGICAL METHODS
LOCAL ANAESTHETICS –Blocks the conduction of nerve impulses –Can be given with adrenaline because •Decreases absorption of L.A allowing larger doses •Also acts on alpha 2 receptors which potentiates analgesic effect
PHARMACOLOGICAL METHODS
NASIDS –Blocks synthesis of PG’s –Only suitable for miledto moderate pain
PRINCIPLE OF MANAGEMENT OF PAIN •Pre-emptive analgesia •Balanced or combination analgesia •Analgesia ladder
PHARMACOLOGICAL METHODS
Balanced Analgesia –NASID are used in conjunction with opioids. –Reduces amount of opioids –Reduces side affect of opioids,ASSESMENT OF PAIN •Observe the behaviour of the patient •Monitor analgesic requirement of the patient –Visual Analogue Score( VAS )
–Verbal Rating Score ( VRS ) •None •Mild •Moderate •severe
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3. INTRODUCTION
Pain refers to an unpleasant sensory and emotional experience
associated with actual or potential tissue damage
It is a protective mechanism of the body Whenever any tissue is
being damaged and it causes the individual to react to remove the
pain stimulus
4. ACUTE
/TRAUMATIC PAIN
SOMATIC PAIN
SUPERFICIAL
PAIN
DEEP PAIN
VISCERAL PAIN
CHRONIC PAIN
NON MALIGNANT OR
BENIGN PAIN
MUSCULOSKELETAL
PAIN
NEUROPATHIC
PAIN
MALIGNANT OR
CANCER PAIN
BASED ON
SOURCE /
LOCATION/REFER
RAL/DURATION
6. QUALITATIVE TYPES OF PAIN SENSATION
FAST PAIN
Felt about 0.1 sec after a pain
stimulus is applied
Sharp, pricking , acute ,
electric pain
Fast sharp pain is not felt in
most deeper tissues of the body
Seen in A delta fibers
SLOW PAIN
Usually begins after 1sec or
more and may range from
seconds to minutes
Slow , burning , aching ,
throbbing , nauseous and
chronic pain
Associated with tissue
destruction
Seen in C fibers
7. OROFACIAL PAIN
Any pain which is felt in the mouth , jaw , and the face and these
pain sensations are carried by the trigeminal nerve
Also used to describe the pain in the region above the neck, in front
of the ears and below the orbitomental as well as pain in the oral
cavity
8. CAUSES OF ORO FACIAL PAIN
Dental
Facial bone disease ( infective,traumatic,neoplastic)
Pathology in related structures(salivary gland ,sinus)
Neurological disorder (trigeminal neuralgia , glossopharyngeal ,
occipital,post herpetic neuralgia)
Vascular(migraine,cluster headache,temporal arteritis)
Psychogenic pain( atypical facial pain , atypical odontalgia,burning mouth
syndrome)
Refferred (MI and angina)
9. NOCICEPTORS
Receptors that are sensitive to painful stimulus and are responsible
for initiating the generation of pain
It is a free nerve ending found in almost all tissues
Identifies tissue injuries and responds to multiple stimulus
These free nerve ending(nociceptors) are attached to the first order
neuron
11. FIRST ORDER NEURONS
These are the cells in the posterior nerve root ganglia , receive impulses from pain
receptors through dendrites
These impulses are transmitted through the axons to spinal cord
Impulses are transmitted by A delta and C fibres
12. Type A fibers
alpha
beta
gamma
delta
type c fibers
Carry tactile and proprioceptive impulse and
not pain
Carries pain sensation pricking pain is
carried by A delta and dull aching burning
is carried by c fibers
13. A DELTA FIBERS
Responsible for temperature and fast or first
pain
Faster with conduction velocity of 12-45
m/sec
Myelinated
Sharp pain
Localized pain
Lasts for short while
Withdrawl reflex
C FIBERS
Responsible for slow or second pain ,
temperature
Much slower with conduction velocity of
0.2-2.0m/sec
Odontogenic pain is associated with C
fibers
Unmyelinated
throbbing , burning , dull pain
Poorly localized
diffused
14. SECOND ORDER NEURON
The neurons of marginal nucleus and substantia gelatinosa form second order
neurons
Fibers from these neurons ascend in the form of lateral spinothalamic tract
Fibers of A delta arise from neurons of the marginal nucleus
Fibers of C arise from neurons of substantia gelatinosa
15. THIRD ORDER NEURONS
The neurons of pain pathway are the neurons in thalamic nucleus , reticular
formation , tectum and gray matter
Axons from these neurons reach the sensory area of cerebral cortex or
hypothalamus
16. Peripheral pain receptors
A delta and c fibers
First order neurons of the dorsal root ganglia
Spinal cord
A delta synapse with marginal cells of grey
horn and c fibers synapse with SG of posterior
grey horn
Second order neuron cross to the opposite side
and ascends as lateral spinothalamic tract
Lateral spinothalamic tract continues as spinal
lemniscus in the brain stem and ends in the
VPL nucleus of thalamus
The third order neurons start at the thalamus
and via the internal capsule reach areas 3,1,2
of primary sensory cortex
17. PAIN IN OROFACIAL REGION
ODONTOGENIC PAIN
refers to pain initiating from the teeth or their
supporting structures i.e mucosa , gingivae ,
maxilla , mandible or periodontal membrane
18. APICAL PAIN
Caused by infection spreading through the apical foramen of the tooth into
apical periodontal region causing inflammation ( apical periodontitis ) and
ultimately a dental abscess if left untreated
19. PERICORONITIS
Pain commonly arises from the supporting gingivae and mucosa
when infection arises from an erupting tooth ( teething or
pericoronitis ) this is the most common cause for the removal of the
third molar teeth ( wisdom teeth ) the pain may be constant or
intermittent but is often evoked when biting down with opposite
teeth
20. INNERVATION OF PERIODONTIUM
Innervation of periodontium and nerve supply of periodontal tissues occurs
through the branches of trigeminal nerve
Trigeminal nerves have motor sensory and intermediated roots which are
mounted directly to the brain
Nerve receptors in the gums , alveolar bone , and periodontal ligament helps to
feel pain , touch and pressure
nerves in the periodontal ligament provides information about the movement
and position of teeth
21. Innervation gums maxillary arch are supplied by superior alveolar
nerves , infraorbital nerve , and palatine branch of nasopalatine
nerve- a branch of second divisions of trigeminal nerve (
maxillary nerve)
Innervation teeth and periodontal ligament
maxillary arch are supplied by superior
alveolar nerves
22. Innervation gums mandibular arch are supplied by mental nerve ,
sublingual branch of lingual nerve - a branch of third divisions of
trigeminal nerve ( mandibular nerve)
Innervation teeth and periodontal ligament
mandibular arch are supplied by lower
alveolar nerve
23. CONCLUSION
Pain although unpleasant , is a protective sensation . The
most important part of managing pain is understanding
the problem and cause of pain and also through the
proper diagnosis and appropriate therapy
