Oral Pain Relief – Strategies To Manage Acute Dental Pain, Update 2020

Oral Pain Relief: health is an integral component of general health. Oral Pains like a cavity, periodontal diseases, and oral cancers are global concerns restricting and confining the day-to-day errands and chores. The 2005 Liverpool Declaration has reaffirmed that oral health should be considered as a basic right. Across the planet, many people experience oral diseases, leading to unneeded pain and suffering.
The International Association for the study of pain defines pain as an “unpleasant sensory and emotional experience related to actual or potential tissue damage or described in terms of such damage.
Dental pain may be a common symptom related to a spread of dental problems like cavity which significantly impacts the oral health-related quality of life.

Oral Pain Relief - Strategies To Manage Acute Dental Pain, Update 2020
Oral Pain Relief

Epidemiological Data

According to the planet Health Survey conducted by the World Health Organization (WHO) in India in 2003, 28% of respondents had suffered from oral ill-health, maximum being from West Bengal. The study conducted by Khan documented that the prevalence of cavity in some parts of India is as high as 60–65%, whereas the prevalence rate is 35% worldwide. An in-depth and comprehensive National Health Survey was conducted in 2004 in India to work out the oral health status and prevalence of dental disease in representative age groups.

Neurobiology and Pathophysiology of Oral Pain Relief

Oral Pain is caused by noxious pain stimuli like bacterial infections, chemical or mechanical erosion of enamel, and recession of the gingiva. Patent dentinal tubules are the primary structure to be involved in dentinal pain signal transduction, post-dental insult. Consistent with the hydrodynamic theory, movement of fluid within the dentinal tubules induces pain via pain fibers located around the odontoblast process and at the pulp-dentine border. A dense network of trigeminal sensory axons closely linked to odontoblasts can also be involved in pain transmission.

It has been well documented that odontoblasts express mechanic- and/or thermo-sensitive transient receptor potential vanilloid (TRPV) ion channels that are likely to sense heat and/or cold movements of dentinal fluid within the tubules. These receptors are transmembrane receptor-ion channel complex and distributed in peripheral, spinal, and central systema nervosum. Within the TRPV family, TRPV-1 receptors are mainly liable for the perception of warming, burning, stinging, or itching sensation

Oral–Patients Interaction

Dentist–patient communication may be a major part of pain management and patient satisfaction. the road of communication could also be direct (face-to-face) or indirect (telephonic/email/chat). In both cases, it’s been observed that patients prefer dentists who are interactive and nondominating in nature. An easy “perceived lack” of caring and/or collaboration by the dentist could also be related to the nonresponsiveness of the patient to the intervention. Positive communication may be key for putting together a patient’s confidence and belief toward further interventions. Without such faith and trust, there could also be a poor “fit” between the intended messages by the dentist and what’s understood by the patient. A study by Lahti et showed that patient expectations were met on the foremost dentist characteristics, except fair support and mutual communication, indicating that more attention must be paid to the communication skills of dentists.

Short, sharp, shooting pain

This type of pain is often generalized because of the tooth sensitivity/dentin hypersensitivity which may be a short, sharp pain caused due to exposed dentin in response to external stimuli. The pain is localized to the affected tooth which may be attributed to fractured dental restorations, cracked cusps, or pulp exposure. Intermittent, shooting, and sharp pains also are diagnostic tic douloureux, so excellent care must be taken to not mistakenly label

Nonpharmacological Methods

Role Of Alternative/Herbal Medications In Dental Pain Management

The major drawback of conventional drug therapies is that the associated side effects. This has led to renewed interest within the use of complementary herbal medicines like oil of cloves, neem leaves, and turmeric, which are popular household remedies for hundreds of years.

According to Lavigne and Sessle, there could also be both “push” and “pull” reasons behind the utilization of those alternative medications. Push reasons comprise dissatisfaction with conventional medicine due to side effects, long waiting lists in clinics, ineffective treatments, and lack of your time. Pull reasons include a belief within the safety and effectiveness of natural, holistic, noninvasive options that are in sync with their philosophy. Treatments range from traditional herbal or Chinese medicine, meditation, biofeedback, physiotherapy, massage, chiropractic therapy, acupuncture, and electric fields, to call a couple of Oral Pain Relief

Oral Pain Relief - Strategies To Manage Acute Dental Pain, Update 2020
Oral Pain Relief

Characteristics of the Herbal Dental Gel

It is a thick, translucent gel, and therefore the constituents impart good spreadability, evenness, instant numbing, and noticeable cooling sensation of menthol when applied orally for Oral Pain Relief.

Clove Oil (primarily eugenol)

Clove oil is the main component exerts the majority of its therapeutic actions, and literature suggests that eugenol and acetyl eugenol are the main constituents of oil of cloves that provide anti-inflammatory action and analgesic benefit for Oral Pain Relief. A piece of writing by Bley reported that eugenol exerts analgesic activity thanks to its anti-nociceptive capacity via TRPV1 receptors. Upon continuous activation, TRPV1 receptors not only increase the permeability of Ca++ ions but also increase its release from the endoplasmic reticulum and other intracellular organelles. These multiple sources of calcium result in higher levels of intracellular calcium and may induce the depolarization of cytoskeletal components like microtubules. Therefore, consistent with these widely known effects, constant exposure of TRPV1 to eugenol results in impaired local nociceptor function for extended periods. Concentration alteration may cause a difference in effects like having either an analgesic or an anesthetic effect.

Camphor For Oral Pain Relief

Camphor features a counter-irritant and mild local anesthetic action, which is effective for Oral Pain Relief in relieving pain thanks to cavity and sensitivity. It also has a cooling and soothing effect which aids in increased patient comfort. Studies have revealed that camphor at higher concentration exhibits significant antibacterial activity against several pathogenic Gram-positive bacteria.

Menthol For Oral Pain Relief

Menthol is primarily used for Oral Pain Relief as a cooling and flavoring agent. A study conducted by Alvarado revealed that menthol produces a cooling sensation by activating transient receptor potential melastatin 8, a nonselective cation receptor.

Polymer Matrix For Oral Pain Relief

The polymer helps form an emulsion of the analgesic oils and also provides a bioadhesive property to the gel when applied to the affected tooth surface it helps fast in Oral Pain Relief.

Clinical Experience With The Herbal Dental Gel

The herbal dental gel is extremely effective in managing acute dental pain thanks to a spread of dental problems like caries, pulpitis (reversible and irreversible), erosion, abrasion, and even in cases like cracked tooth syndrome. However, the herbal gel should be considered as a symptomatic treatment only and patients got to visit a dentist for correct diagnosis and definitive treatment. Additionally, efforts should be made to explore other therapeutic areas or clinical conditions to further extend its scope, for instance, in alveolitis, etc.

Algorithm for Oral Pain Relief

An algorithm on dental pain management establishing the role of herbal dental gel is often used as a ready reference for dental practitioners to follow [Figure 8]. Treatment ideally should start with the initial phase of building rapport to ease and luxury patients in pain. it’s essential to elucidate the source of dental pain with a thorough review of the patient’s medical and dental history and clinical/diagnostic examination. The gel or other relevant intervention should be recommended once an odontogenic explanation for dental pain is confirmed by preliminary tests or radiographic examination.

Conclusion

Present targets for pain management are related to multiple limitations for Oral Pain Relief, and therefore, the exploration of newer pathways/alternatives (TRPV1-related) is of utmost priority. The herbal dental gel may be a unique formulation of three essential oils, namely, clove oil, camphor, and menthol which renders it effective in dental pain management when applied locally.
A favorable clinical experience with the novel herbal dental gel implied it:
Can be a “home remedy” or as a “ first aid” for symptomatic relief of dental pain
It can be useful in managing dental pain in a certain group of patients like geriatrics, busy professionals, and patients with special needs It is asymptomatic treatment.

However, need exists for more studies and investigations to debate other clinical/therapeutic indications for this herbal gel in practice .m

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