Pain management following dental trauma and surgical procedures.

Surgical procedures and post traumatic management of dental patients require effective pain management during treatment, but being considerably more invasive than conservative treatments, pain management is required into the post-operative period. Clinical trials on pain intensity following dental surgical procedures (e.g., 3 rd molar extraction, implant placement, periodontal and endodontic surgery) have shown that pain is most intense approximately 5 to 6 hours after completion of the procedure, reaching its peak levels during the first postoperative day. Greatest consumption of analgesics occurs during the first 48 to 72 hours after 3 rd molar extraction. For the management of perioperative pain associated with either conservative or surgical dental treatment, the local anesthetics articaine, lidocaine, mepivacaine and prilocaine are preferred. These drugs, with a vasoconstrictor, provide a rapid onset and a duration of pulpal anesthesia adequate to complete most dental and surgical procedures painlessly. For management of post traumatic and postsurgical pain, bupivacaine - administered by an appropriate nerve block - near the conclusion of a surgical procedure, can provide the patient with a pain-free period of up to 12 hours. Non-steroidal anti-inflammatory drugs represent the most effective drugs for the management of dental post-surgical pain. NSAIDs, as a group in therapeutic doses, have Numbers Needed to Treat ranging from 2 to 3, while those for opioid analgesics do not approach those for NSAIDs. A protocol for management of pain following surgical procedures and traumatic injuries is discussed in this paper and includes pre-emptive NSAID; perioperative pain management; post-operative pain management - local anesthesia; post-operative pain management - analgesics; post-operative telephone call.