Authors: Dionne RA.
Title: Pain control in dentistry: the basis for rational therapy.
Journal: Compend Contin Educ Dent
Date: Jan 1985
Citation: 6(1):15-6, 18, 20-2 passim
Category: Endodontic Pharmacology
Evidence-based Ranking: 5
Discussion: This review article identifies the scientific foundation for pain control in dentistry and the benefits and limitations of the most commonly employed behavioral and pharmacologic methods. The goal is the delineation of rational therapy based on the patient’s needs, the clinician’s training, and the relative safety of the drugs used. - Clinicians must balance the therapeutic benefits against the potential for toxicity when selecting the appropriate treatment for pain control. - Pain control also extends to the treatment of chronic orofacial pain, and the agent used should be critically evaluated prior to its use. Evaluation of Pain Control Modalities: - The strength of the placebo response - Cyclic Fluctuations and Spontaneous Remissions of the disease process - Patient and Clinician Bias - The Role of Chance - Influence of the Evaluation Criteria - The need to control factors that mimic clinical success Scientific Basis for Pain Control in Dental Patients: The perception of pain is the result of a complex series of events. The following sections include discussion of the phsyiologic response to pain in both: - Initiation of Painful Sensations - Transmission of the Pain Impulse

Author’s Conclusion: Knowledge of the neurophysiologic, neuroendocrine, and psychologic processes contributing to the endogenous pain inhibitory mechanisms will lead to a rationale for selecting from the therapeutic choices available to clinicians. Knowledge of the mechanisms of action and of the relative efficacy and toxicity of the various classes of pharmacologic agents permits a rational choice of therapeutic agents and combinations.