Pain and analgesic use in endodontics

Yıl 2013, Cilt: 4 Sayı: 1, 39 - 45, 31.03.2013

Bulem Ureyen Kaya , Emre Çiçek Halil Aşçı

Öz

Dental pain is an undesirable situation for both the clinician and the patient. Clinician should overcome this discomfortable situation. Understanding of the pain system, a good endodontic dental procedure and the use of appropriate analgesics are important steps in management of dental pain. Pain system starting with the signal detection of tissue damage in the periphery, ongoing processing of data at the level of the spinal cord, perceived at the high brain regions such as cerebral cortex is a multilevel and complex system. A clinician who understands all levels of the pain system basically can perform effective methods of pain control by getting the opportunity of using therapeutics. There are thin, unmyelinated C fibers and Aδ fibers which is small and less myelinated in the pulp for the pain perception. Non-narcotic and narcotic analgesics are prefered to manage endodontic pain. Acetaminophen and non-steroidal antiinflammatory drugs or opioid analgesics and combinations of these drugs are frequently used in endodontic pain management. In this review information will be given about the mechanism of endodontic pain, transmission paths and analgesics used for pain management.

Keywords: Analgesic, dental pain, endodontics, non-steroidal antiinflammatory, pulpitis.

Anahtar Kelimeler

Analgesic, dental pain, endodontics, nonsteroidal antiinflammatory, pulpitis

Endodontide ağrı ve analjezik kullanımı

Öz

Dental ağrı hem hekim hem de hasta için istenmeyen bir durumdur. Hekim bu durumun üstesinden gelebilmelidir. Ağrı sisteminin anlaşılması, iyi bir endodontik prosedür ve uygun analjeziklerin kullanımı dental ağrının kontrolünde önemli adımları oluşturmaktadır. Ağrı sistemi, periferde doku hasarı yapan uyaranın tespiti ile başlayan, verinin omurilik düzeyinde işlenmesiyle devam eden, serebral korteks gibi yüksek beyin bölgelerinde algılanan, çok seviyeli ve kompleks bir sistemdir. Temel olarak ağrı sisteminin her seviyesini anlayan bir klinisyen, terapötikleri kullanma fırsatını yakalayarak etkili ağrı kontrol metodlarını uygulayabilir. Pulpada ağrı algılanmasında ince ve myelinsiz olan C fibrilleri ile küçük ve daha az myelinli olan Aδ fibrilleri bulunmaktadır. Narkotik ve non-narkotik analjezikler endodontik ağrıyı yönetmek için tercih edilir. Endodontik ağrının yönetiminde asetaminofen ve non steroid antiinflamatuvar ilaçlar veya opioid analjezikler ile bu ilaçların kombinasyonları sıklıkla kullanılmaktadır. Bu derlemede endodontik ağrı mekanizması, iletim yolları ve ağrı yönetimi için kullanılabilecek analjezikler hakkında bilgi verilecektir.

Anahtar Kelimeler: Analjezik, dental ağrı, endodonti, non steroid antiinflamatuvar, pulpitis.

Anahtar Kelimeler

Analjezik, dental ağrı, endodonti, non steroid antiinflamatuar, pulpitis

Kaynakça

• Keiser K ve Byrne BE. Endodontic pharmacology. Hargreaves KM, Cohen Stephen, ed. Pathways of the pulp. St. Louis, Missouri: Elsevier, 2011: 671- 690.
• Byers MR, Narhi MV. Dental injury models: experimental neuroinflammatory interactions and polymodal nociceptor functions. Crit Rev Oral Biol Med. 1999; 10: 4-39. for understanding
• Johnsen DC, Harshbarger J, Rymer HD. Quantitative assesment of neural development in human premolars. Anat Rec 1983; 205: 421-429.
• Trowbridge HO. Review of dental pain-histology an physiology. J Endod. 1986; 12: 445-452.
• Fehrenbacher J, Sun XX, Locke E, Henry M. Hargreaves KM. Capsaicin-evoked ICRP release from human dental pulp: a model system for the study of peripheral neuropeptide secretion in normal healthy tissue. Pain 2009; 144: 253-261.
• Guyton AC, Hall JE. Textbook of Medical Physiology, 10 th ed. Philadelphia: WB. Saunders Company, 2001.
• Byers MR, Taylor PE, Khayat BG, and Kimberley CL. Effects of injury and inflamation on pulpal and periapical nerves. J Endod 1990; 16: 78-84.
• Fried K and Risling M. Nerve growth factor receptor-like immunoreactivity in primary and permanent canine tooth pulps of the cat. Cell Tissiue Res 1991; 264: 321-328.
• Goodies HE, Bowles WR, and Hargreaves KM. Prostaglandin E2 enhances bradykinin-evoked İCGRP release in bovine dental pulp. J Dent Res 2000; 79: 1604-1607.
• Chang MC, Chen YJ, Tai TF, Tai MR, Li MY, Tsai YL, Lan WH, Whang YL, Jeng JH. Cytokine- induced prostaglandin E2 production and cyclooxygenase-2 expression in dental pulp cells: Downstream calcium signalling via activation of prostaglandin EP receptor. Int Endod J 2006; 39: 819-826.
• Nakanishi T, Matsuo T, and Ebisu S. Quantitative analysis of immunoglobulins and inflammatory factors in human pulpal blood from exposed pulps. J Endod 1995; 21: 131-136.
• Shimauchi H, Takayama S, Miki Y, Okada H. The change of periapical exudate prostaglandin E2 levels during root canal treatment. J Endod 1997; 23: 755-758.
• Wheeler EF, Naftel JP, Pan M, von Bartheld CS, Byers MR. Neurotrophin receptor expression is induced in a subpopulation of trigeminal neurons that label by retrograde transport of NGF or fluoro- gold following tooth injury. Brain Res Mol Brain Res 1998; 61: 23-38.
• Lepinski AM, Hargreaves KM, Goodies HE, Bowles WR. Bradykinin levels in dental pulp by microdialysis. J Endod 2000; 26: 744-747.
• Hargreaves KM, Milam SB. Mechanisms of pain and analgesia. In: Dionne R, Phero J. Management of pain and anxiety in dental practice, New York: Elsevier, 2001; 18-40.
• Keiser K, Hargreaves K. Building effective strategies for the management of endodontic pain. Endod Topics 2002; 3: 93-105.
• Sessle B. Recent developments in pain research: central mechanisms of orofacial pain and its control. J Endodon 1986; 12: 435-444.
• Dallel R, Clavelou P, Woda A. Effects of tractotomy on nociceptive reactions induced by tooth pulp stimulation in the rat. Exp Neurol 1989; 106: 78- 84.
• Marriott D, Wilkin GP, Coote PR, Wood JN. Eicosanoid synthesis by spinal cord astrocytes is evoked by substance P; possible implications for nociception and pain. Adv Prostaglandin Thromboxane Leukot Res. 1991; 21B: 739-741.
• Seesle BJ, Hu JW, Amano N, Zhong G. Convergence of cutaneous, tooth pulp, visceral, neck and muscle afferents onto nociceptive and non-nociceptive neurones in trigeminal subnucleus caudalis (medullary dorsal horn) and its implications for referred pain. Pain 1986; 27: 219-235.
• Bunczak-Reah M, Hargreaves K. Effect of inflammation on delivery of drugs to dental pulp. J Endod. 1998; 24: 822-825.
• Dionne RA. Additive analgesic effects of oxycodone and ibuprofen in the oral surgery model. J Oral Maxillofac Surg. 1999; 57: 673-679.
• Hargreaves K, Troullos E, Dionne R. Pharmacologic rationale for the treatment of acute pain. Dent Clin North Am. 1987; 31: 675-694.
• Hargreaves KM, Keiser K. New advances in the management of endodontic pain emergencies. J Calif Dental Assoc. 2004; 32: 469-473.
• Kayaalp O. Rasyonel tedavi yönünden Tıbbi Farmakoloji, 12 th ed. Ankara: Pelikan Yayınları, 2009; 837-870.
• Doroschak AM, Bowles WR, Hargreaves KM. Evaluation of the combination of flurbiprofen and tramadol for management of endodontic pain. J Endod 1999; 25: 660-663.
• Holstein A, Hargreaves KM, Niedeiman R. Evaluation of NSAIDs for treating post-endodontic pain. Endod Topics 2002; 3: 3-13.
• Hashioka K, Yamakasi M, Nakane A, Horiba N, Nakamura H. The relationship between clinical symptoms and anaerobic bacteria from infected root canals. J Endod 1992; 18: 558-561.
• Siqueira JF, Rocas IN, Rosado AS. Investigation of bacterial communities associated with asymptomatic and symptomatic endodontic infections electrophoresis fingerprinting approach. Oral Microbiol Immunol 2004; 19: 363-370. gel
• Sedgley CM, Molander A, Flannagan SE, Nagel AC, Appelge OK, Clewell DB, Dahlen G. Virulence, phenothype and genotype characteristics of endodontic Enterococcus spp. Oral Microbiol Immunol 2005; 20: 10-19.
• Reynaud af Geijersstam A, Culak R, Molenaar L, Chattaway M, Roslie E, Peciuline V, Haapasalo M, Shah HN. Comparative analysis of virulence determinants and mass spectral profiles of Finish and Lithuaninan endodontic Enterococcus faecalis isolates. Oral Microbial Immunol 2007; 22: 87-94.
• O’Neill LA. Immunology after the toll rush. Science 2004; 303: 1481-1482.
• Wadachi R, Hargreaves KM. Trigeminal nociceptors express TLR-4 and CD 14: A mechanism for pain due to infection. J Dent Res 2006; 85: 49-53.
• Baumgartner JC, Falkler WA, Jr. Biosynthesis of IgG in periapical lesion explant cultures. J Endod 1991; 17: 143-146.
• Hahn CL, Best AM, Tew JG. Cytokine induction by Streptococcus mutans and pulpal pathogenesis. Infect Immun 2000; 68: 6785-6789.
• Poltorak A, He X, Smirnova I, Liu MY, Van Huffel C,Du X, Birdwell D, Alejos E, Silva M, Galanos C, Freudenberg M, Ricciardi-Castagnoli P , Layton B, Beutler B. Defective LPS signaling in C3 H/HeJ and C57 BL/10ScCr mice: Mutations in Tlr4 gene. Science 1998; 282: 2085-2088.
• Qi HY, Shelhamer JH. Toll-like receptor 4 signaling regulates cytosolic phospholipase A2 activation and lipid generation in lipopolysaccharide- stimulated macrophages. J Biol Chem 2005; 280: 38969-38975
• Dionne R. Suppression of dental pain by the preoperative administration of flurbiprofen. Am J Med Sci 1986; 80: 41-49.
• Arnold J, Salom I, Berger A. Comparison of gastrointestinal microbleeding associated with use of etodolac, ibuprofen, İndomethacin, and naproxen in normal subjects. Curr Ther Res 1985; 37: 730-738.
• Cooper S, Berrie R. Cohn P. The analgesic efficacy of ketoprofen compared to ibuprofen and placebo. Adv Ther 1988; 5: 43-53.
• Dionne R. COX-2 inhibitors: better than ibuprofen for dental pain? Compendium 1999; 20: 518-524.
• Khan AA, Dionne AA. The COX-2 inhibitors: new analgesic and anti-inflammatory drugs, Dent Clin North Am 2002; 46: 679-690.
• Ehrich EW, Dallob A, De Lepeleire I, Van Hecken A, Riendeau D, Yuan W, Porras A, Wittreich J, Seibold JR, De Schepper P, Mehlisch DR, Gertz BJ. Characterization of rofecoxib as a cyclooxygenase inhibitor and demonstration of analgesia in the dental pain model. Clin Pharmacol Ther 1999; 65: 336-347.
• Nakanishi T, Sbimuzu H, Matsu O T. cyclooxygenase-2 in human dental pulp. J Dent analysis of