Pain Management: Theory of Pain Control

Indiana HB 1172

• Allows dental hygienists to administer local anesthesia under direct supervision and expands the current law to allow prescriptive supervision in hospitals, clinics, fixed charitable institutions, public health settings and correctional institutions.

• Under prescriptive supervision, the physical presence of a dentist is not required, but the dentist must have examined the patient and prescribed the patient care within the previous 45 days

Pain and Anxiety Management

Dental fear or anxiety affects about ¾ of the total world’s population

To recognize a patient’s anxiety and pain is an integral component of the dental hygiene care plan

Components of pain

-Pain perception-neurologic experience

-Pain reaction-interpretation and response to the pain message

Dental phobia

-Situation is avoided or endured with intense anxiety

-Interferes with normal routine

Dental fear and anxiety

-Dental fear is defined as an unpleasant mental, emotional, or physiologic sensation derived from a specific dental-related stimulus

-Dental anxiety is nonspecific, unease, apprehension, or negative thoughts about what may happen during a dental appointment (anticipation)

-80% happens during childhood/adolescence

Pyschogenic

A patient’s anticipation leading up to an injection may lead to hyper-ventilation and/or syncope

Thorough review of medical history and discussion with the patient may give the professional the insight to reduce or prevent negative psychogenic responses

Patient fear of dental procedures

Understanding and acknowledging a patient’s fear of the needle or a specific dental procedure may help to reduce their anxiety

Sensory cues

-In treatment areas keep instruments, needle, and the syringe out of patient’s sight

-The syringe should be passed behind the patient’s head so the needle is not seen

Behavior management techniques

• Tell-show-do

• Behavior modeling

• Distraction

• Relaxation therapy

• Guided imagery

• Progressive relaxation

• Systematic desensitization (specialized training)

• Hypnosis (specialized training)

Management of the patient

Build patient trust

Communication

Tell-show-do

Traditional pain control methods

• Topical anesthetics

• Desensitizers

• Nitrous oxide-oxygen sedation

• Local anesthetics

• IV sedation

• Sedatives/anti anxiety meds

• General anesthesia