Postextractional pain management

Abstract

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.

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“…However, adjacent teeth and anatomical structures may be also involved. The inflammatory component and mechanical trauma play an important role in the genesis of pain [5].…”