ANES PRELIMS LEC

Analgesia

state or condition characterized by absence of all sensation

LOCAL ANESTHESIA

A loss of sensation in a circumscribed area of the body by depressed excitation of nerve endings

Horace Wells

came up with the idea of using NO2

Dr William T.G. Morton

public demonstration of ether

Dr. Oliver Wendell Holmes sr.

suggested the word anesthesia

James Young Simpson

introduced chloroform

Dr. Crawford W. Long

first surgical operation under anesthesia

Albert Niemann

first isolated cocaine

Karl Koller

used topical cocaine solution in eye surgery

William S. Halsted

first wisdom tooth extraction using LA

Alfred Einhorn

synthesis of procaine

Novocaine

first ester type LA

Lidocaine

first amide type LAA

• Nerve compression,

• Paralyzant Method,

• Tissue Anoxia,

• Refrigerant Method

outdated methods of LA

Pain

most common unpleasant symptom associated with dentistry

relief of pain

primary objective

Pain Perception

involves afferent transmission of an impulse

Action Potential

electrical current or small electrical charges that travel along the length of a nerve

Pain Reaction

represents an individual’s overt manifestation of the painful experience

Sensory Neuron

conducts messages from peripheral tissue. responsible for perception of pin, pressure, temperature, touch

Motor Neuron

transmits command from the CNS to periphery. responsible for muscle movements, epinephrine release

Axon

sensory neuron consist of free nerve endings near periphery and cable-like nerve fibers

-70 to -90 mV

normal resting state of nerve

• Normal resting state of nerve

• slow depolarizaion

• threshold potential

• rapid depolarization

• repolarization

physiology of impulse conduction

Specificity Theory

transmission of pain is via “straight through” channels from the skin to the brain

Rene Descartes

created the specificity theory

Johannes Mueller

proposed that these straight-through channels used sensory neuron

Maximillian Von Frey

Postulated the idea of a pain center within the brain

Goldscheider

created the pattern theory

Pattern Theory

Proposed that stimulus intensity and central summation are critical determinants of pain

Ronald Melzack and Patrick D. Wall

created the gate control theory

Gate control theory

The transmission of nerve impulses from afferent fibers to the spinal cord is modulated by a gating mechanism in the dorsal horn.

large fibers

tends to inhibit transmission (close the gate)

small fiber

activity tends to facilitate transmission (open the gate)

SUBSTANCIA GELATINOSA

Propose that intentional stimulation of fast conducting large diameter nerve fibers (initiated by pressure vibration and temperature) results in the inhibition of transmission of pain sensation by small nerve fibers

DESCENDING CONTROL

A specialized system of large-diameter, rapidly conducting fibers (The central control trigger) activates selective cognitive processes that then influence, by way of descending fibers, the modulating properties of the spinal gating mechanism

ACTION SYSTEM

A complex interconnection of high nervous system centers that subserve emotions- attention memory, spatiotemporal analysis and effect and several motor mechanisms

SENSORY-DISCRIMINATIVE COMPONENT

Enables an individual to identify location and duration of pain

MOTIVATIONAL-AFFECTIVE COMPONENT

Provides for the aversive-motivational component of pain, the “suffering” aspect associated with pain

Aversive-motivational

tells you to avoid the things that would cause pain

DESCENDING CONTROL

Control mechanisms of inhibiting or facilitating neural transmissions located within the PAG

Synesthesia

is the overlapping of senses

SOMATOGENIC

typically affects a specific area of the body and often worsens with movement. It is considered nociceptive, meaning it results from an injury, inflammation, or pressure.

Nociceptive

pain in peripheral nerves

Neuropathic

difficult to diagnose because the damage is on the nerve itself

PSYCHOGENIC PAIN

has no organic basis; doesn’t follow a definite anatomic pattern

REFERRED PAIN

pain experienced at a site far away from the site of the injury

NEUROGENIC PAIN

sharp, burning, intense pain that may be constant or intermittent

VASCULAR PAIN

diffuse, difficult to localize (i.e., Arthritis); in smooth muscles and blood vessels

MUSCLE PAIN

dull and limited to area of origin; movement of the affected part worsens the pain

• DURATION AND SEVERITY

• ANATOMICAL LOCATION

• BODY SYSTEM INVOLVED

• CAUSE

• TEMPORAL CHARACTERISTICS

IASP CLASSIFICATION SYSTEM

• Removing the cause

• Blocking pain pathway

• Raising pain threshold

• Preventing pain reaction by cortical depression

• Using psychosomatic methods

HOW CAN PAIN BE CONTROLLED?

Blocking pain pathway

Most commonly used method of pain control in dentistry

Using psychosomatic methods

Gain the patient’s confidence and trust

Trigeminal

5th cranial nerve and largest cranial nerve

Facial

7th cranial nerve

Glossopharyngeal

9th cranial nerve

Hypoglossal

12th cranial nerve

Side of pons

origin of cranial nerve

Superior orbital fissure

V1 exits

Foramen Rotundum

V2 exits

Foramen Ovale

V3 exits

Ophthalmic branch

smallest division of largest cranial nerve

Superior orbital fissure

foramen of ophthalmic branch

• Scalp

• skin of forehead

• upper eyelid

supplied by the ophthalmic branch

Lacrimal Nerve

smallest branch of smallest division

• Lacrimal Gland

• Conjunctiva

• Upper Eyelid

supplied by the lacrimal nerve

Frontal Nerve

Largest branch of smallest division

• Skin of forehead

• upper eyelid

• frontal sinus

supplied by frontal nerve

Supraorbital and supratrochlear

branches of frontal nerve

Nasociliary Nerve

sympathetic division of ANS by way of ciliary nerves

Maxillary Branch

supplies all maxillary teeth and their gingivae, mucous membrane of most of the nasal cavity, hard and soft palate, etc

Sphenoidal Bone

bone of maxillary branch

Middle meningeal nerve

supplies dura mater of brain

Inferior Orbital fissure

where zygomatic nerve is located

zygomatico-Facial Nerve

supplies side of the face

Zygomatico-temporal nerve

supplies side of the head going to the skull

Pterygopalatine Nerve

supplies periosteum of orbit, posteriorethmoid cells and sphenoid sinus

Medial and Septal Nasal Branch

supplies Vomer

Nasopalatine Nerve

supplies anterior ⅓ of the hard palate

Incisive fossa

where nasopalatine nerve is located

Greater Palatine Nerve

supplies posterior ⅔ of hard palate

• Middle Palatine Nerve

• Posterior Palatine Nerve

branches of inferior plexus

Middle palatine nerve

supplies soft palate

posterior palatine nerve

supplies tonsillar area

Posterior superior alveolar nerve

supplies molars (excepr 1st) and periodontal tissues

Anterior superior alveolar nerve

supplies upper anterior teeth (incisors to canines)

Middle superior alveolar nerve

supplies premolars and mesiobuccal root of 1st molars

inferior palpebral branch

supplies lower eyelid

Lateral nasal nerve

supplies side of nose

Superior labial nerve

supplies upper lip

foramen ovale

where the mandibular branch exits

mandibular branch

largest branch of the trigeminal

undivided nerve

non dental portion of the mandibular branch

nervus spinosus

supplies dura, portion of posterior anterior area of brain and branches to internal pterygoid muscle

anterior division of divided nerve

sipplies sensory and motor fibers for muscles of mastication

long buccal nerve

innervates portion of buccal tissue of mandibular molars

auriculo-temporal nerve

supplies tragus of ear

mental nerve

supplies external auditory meatus and tympanic membrane

Chorda tympani

plays the role in sensation of taste from CN VII