Dental pain is amongst the most common types of or ofacial pain, it significantly reduces quality of life in patients and is regarded as a serious public health issue in many countries, furthermore it is main reason of seeking emergency dental treatment. Usually dental pain is caused by pulp and periapical conditions and is inflammatory. The two key components of dental pain are the activity of nerve fibers and alterations in microciculation. Anatomical and neurophysiological differences affecting mentioned type of pain were presented in this paper as well as mechanisms of dental pain form ation, clinical implications of hyperalgesia, allodynia, reffered pain phenomena and therapeutic procedures. The most optimal way of preoperative pain management is implementation of causal treatment as soon as possible, which includes tooth extraction or endodontic intervention. During root canal treatment complete pulp removal is followed by exact chemomechanical preparation of the entire root-canal system with the use of instrumentation and plentiful irrigation and dense obturation. Endodontic therapy allows tooth preservation and periapical tissues healing. Intraoperative pain is controlled with the means of proper local anaesthesia, depending on clinical situation using not only first choice techniques as regional block and infiltrative anaesthesia but also additional methods like intraligammentary, intraosseus and intrapulpal injections. Postprocedural pain management starts during anaesthesia. In article additional pharmacological and non-pharmacological strategies helpful in treating these conditions, providing better effectiveness of local anaesthesia that is difficult in tissue inflammation and decreasing and even preventing development postendodontic pain – common complication of root canal treatment.

Tooth extraction that is tooth removal is one of the most common surgical procedures in the dental practice. Like every surgical treatment tooth extraction is a tissue injury. Because during the procedure pain is controlled by the means of local or general anaesthesia post-procedural complaints are common, crucial, and inevitable problem. There is a varying degree of pain severity between patients depending on the level of complexity of the procedure – the pain reported after surgical extractions involving bone removal and tooth sectioning is significantly higher than in the cases of simple, uncomplicated tooth extraction. Intensity of pain is also higher in cases where the inflammation is present. In most cases the pain is acute in character and is usually localised to the extraction site, it can however affect the adjacent tooth on times. The inflammatory component together with mechanical trauma play a significant role in the etiology of postextractional pain. Alveolar osteitis, known as ‘dry socket’, is a special case of postprocedural complication with high pain intensity. The phenomenon relates to the blood clot resolution, which is the most optimal extraction wound dressing. In the paper pre-, intra- and postprocedural strategies were discussed, including general and local pharmacological actions and non-pharmacological actions including physical ones like cold compress and alternative methods like acupuncture, electroacupencture, transcutaneous nerve stimulation or conditioned pain modulation. Furthermore treatment of ‘dry socket’ a painful tooth removal complication was presented.

W stomatologii dziecięcej kontrola bólu śródzabiegowego uzyskiwana jest dzięki znieczuleniu miejscowemu, jednak, paradoksalnie, samo podanie roztworu leku związane jest z lękiem, niepokojem, dyskomfortem, a nawet bólem pacjenta. Już sam widok igły może przyczyniać się do wystąpienia silnego lęku u najmłodszych, który może wzmagać odczuwanie doznawanego bólu i dyskomfortu. Ból podczas podania znieczulenia miejscowego jest związany z perforacją tkanek przez igłę oraz ich rozpieraniem przez roztwór znieczulający. Lekarze dentyści dysponują szeregiem metod, pozwalających na zmniejszenie bólu i dyskomfortu związanego z iniekcją znieczulenia miejscowego. Znaczną pomoc dla stomatologów dziecięcych stanowią zarówno alternatywne wobec tradycyjnej strzykawki systemy znieczulające, modyfikacje sposobu podawania, jak i samego roztworu. Często w praktyce iniekcyjne znieczulenie miejscowe poprzedzane jest zastosowaniem działającego powierzchniowo na śluzówkę żelu, sprayu lub kremu znieczulającego, którego skuteczność można podnieść przez zastosowanie jontoforezy, która zwiększa głębokość penetracji środka do tkanek. W artykule omówiono także metody pozafarmakologiczne, takie jak zastosowanie laseroterapii, przeciwstymulację oraz strategie behawioralne, których zastosowanie pozwoli na bezbolesne i komfortowe przeprowadzenie najdelikatniejszego z zabiegów stomatologii dziecięcej, jakim jest znieczulenie miejscowe. Zapobieżenie wystąpienia bólu wpływa na reakcje dziecka podczas kolejnych wizyt, kształtuje jego zaufanie do lekarza, przyczyniając się do utrzymania zdrowia jamy ustnej.

Intra-operative pain management with the means of local anaesthesia is an important of dental practice. Local anaesthetics are drugs the most commonly used drugs in dentistry, being, at the same time, the safest and most effective pain preventing and pain relieving agents known to medicine.The mechanism of action of local anaesthetics involves interruption of the conduction of nerve impulses. These agents show high affinity for the voltage-dependent sodium channels (Nav), they block them, thus preventing the influx of sodium cations through the membranes of the neuron. The potential threshold is not reached and the potential itself is not present. The potency of local anaesthetic drugs depends primarily on the concentration of the solutions used, while possible side effects depend on the dose. In this paper the characteristics of local anaesthetics used in dental practice were presented as well as characteristics of vasoconstrictors added to anaesthetic solutions. The historical outline, the mechanism of action of local anaesthetics and the currently used both basic and additional methods of anaesthesia are discussed. Possible strategies for improving the effectiveness of anaesthesia by the means of physical and chemical methods were explained. General and local adverse reactions of dental anaesthetics were also discussed, along with ways to prevent and treat them.

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