Pain involves a myriad of physiochemical responses leading to the perception of an unpleasant sensation arising from tissue damage. An understanding of the terminology and basic neurophysiology involved with the pain process is helpful in preventing and treating discomfort in our patients. A general understanding of the concepts of nociception, peripheral sensitization, and central sensitization will allow decisions to be made on the choices of analgesic agents in each individual patient based upon the type, duration, and severity of the pain. Using preemptive pain management with a multimodal approach provides the most consistent and predictable results. Analgesic protocols should be closely scrutinized on an individual basis with careful patient pain assessment during the postoperative period. Chronic pain mechanisms, particularly significant in cancer pain and stomatitis, require aggressive and perhaps unique approaches to ensure maximum patient comfort. NociceptionNociception is defined as the processing of a noxious stimulus resulting in the perception of pain by the brain (Fig. 1). 1 The components of nociception include transduction, transmission, and modulation. 2 Transduction is the conversion of a noxious stimulus (mechanical, chemical, or thermal) into electrical energy by a peripheral nociceptor (free afferent nerve ending). Transmission involves impulse propagation from the site of oral injury primarily through the trigeminal afferent nerves.Nerve fibers involved include A-delta (fast) fibers responsible for the initial sharp pain, C (slow) fibers that cause the secondary dull, throbbing pain, and, A-beta (tactile) fibers that have a lower threshold of stimulation. Modulation in the oral cavity occurs when neurons from these fibers synapse with nociceptive-specific and wide dynamic range neurons in the nucleus caudalis located in the medulla. 3 This brain tissue is very similar to that of the spinal cord dorsal horn that modulates pain from areas other than the oral cavity. 3 Located within the excitatory synapse, neuropeptides such as glutamate and substance P facilitate the pain signals by binding to their receptors on these neurons. 2 At the same time, endogenous (opioid, serotonergic, and noradrenergic) descending analgesic systems serve to dampen the nociceptive response. 2 Peripheral SensitizationSurgical manipulation of tissues within the oral cavity results in a greatly enhanced nociceptor response to any additional stimulus postoperatively. This enhanced response is termed peripheral sensitization (hyperalgesia). 4 Primary hyperalgesia occurs when peripheral hyperalgesia develops at the site of injury. ATP, potassium ions, hydrogen ions, prostaglandins, bradykinin, and nerve growth factors are all released by the damaged tissue FOUNDATIONS

A 13-year-old, male/neutered Border Collie dog was diagnosed with a radicular cyst of the left premaxilla. Tooth extraction and curettage of the lesion resulted in a positive clinical outcome 6-months following treatment.

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This case report describes the use synthetic bone graft particulate and 24% EDTA gel to treat an infrabony defect adjacent to the mandibular right first molar tooth in an American Eskimo dog. Postoperative examination 33-months following surgery showed osseous integration at the infrabony defect and restoration of the periodontal ligament space with a small refractory periodontal pocket.

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