Managing Acute Dental Pain Emergencies with Professor Ken Hargreaves

Professor Hargreaves's area of research focuses on the pharmacology of pain and inflammation and he will be speaking at IDEM Singapore from 4-6 April 2014 on the latest developments in NSAIDS, paracetamol-containing analgesics and local anaesthetics and their application in acute dental emergencies.

Q What are the factors that can contribute or hinder proper management of acute dental pain emergencies?

A Ideal pain control starts before you even see your patient. Developing a logical and efficient plan before the emergency allows the clinician to be much more efficient when treating these patients and maximizes the results. One great way to develop this plan is to attend CE lectures devoted to this topic like at IDEM.

Q How important is a proper diagnosis in determining the cause of pain?

A Our pain control plan is called the "3D" approach, which consists of Diagnosis, Dental Treatment and Drugs. An accurate diagnosis is the first and essential step for treating any emergency.

Q What else could be done to manage the pain when a proper diagnosis couldn't be reached other than referring?

A Understanding mechanisms of dental pain and the role of central sensitisation in referred pain will greatly reduce the number of cases where a pain diagnosis cannot be made. Using the latest evidence, the vast majority of acute pain emergencies can be rapidly diagnosed and treated.

Q How should NSAIDs, analgesics and anaesthetics be used, on their own or in combination with each other?

A Fortunately, there are an increasing number of clinical trials demonstrating the analgesic benefits as well as potential adverse effects of different analgesics and anaesthetics for treating pain emergencies. Using these studies, one can develop an efficient and logical approach for using these drugs either alone or in combinations capable of producing synergistic relief of acute pain.

Q To what extent can dentists adjust the prescription and administration of drugs to suit individual patients?

A Other than treating children, where dose ranges are highly developed, the primary factor in selecting drugs and their combinations is the level of pre-operative pain. The rationale for using pre-op pain as a decision point is based on the finding that pain before a dental procedure highly predicts pain after the procedure.

Q When using LA, why is it important to use long-acting ones?

A Long acting LA helps reduce central sensitisation and therefore can reduce pain for days after a single injection.

Q What are the pros and cons of pre-treating with NSAIDs vs paracetamol?

A New evidence is emerging on the benefits and potential adverse effects of these drugs when administered alone or in combination. The latest results will be distilled into clinical guidelines and given at my talks at IDEM Singapore 2014