Pain
• It is perhaps the most commonly experienced symptom in dentistry.
• Yet, a precise definition of pain does not exist as pain has a subjective/ psychophysiological aspect (a painful stimuli for one individual may
...
Pain
• It is perhaps the most commonly experienced symptom in dentistry.
• Yet, a precise definition of pain does not exist as pain has a subjective/ psychophysiological aspect (a painful stimuli for one individual may not be painful for another)
• Arbitrarily, pain can be defined as any unpleasant experiences may it be emotional, mechanical/physical or chemical with or without tissue damage.
Dual nature of Pain
• Pain like other sensations (touch, hot, cold, etc.) has a physioanatomical aspect which explains the physiological processes and anatomical parts involved in Pain Perception.
• In addition pain also has a Psychophysiological aspect that is unique to each individual. it explains the psychological factors associated with Pain Reaction.
Theories of pain
1. Specific theory:
• Developed by Descarets in 1644
• Describes pain systems as a straight-through channel from the skin to the brain
• Presence of specific nerve ending for pain perception called Nociceptors.
• These nociceptors once activated carry the unpleasant experience to “Pain Center” within the brain
2. Pattern Theory
• Developed by Goldscheider
• Pain are produced by the summation of sensory input
3. Gate control theory
• – Proposed by Melzack and Wall
• Claims the existence of a so called “gate” in the spinal cord that controls the passage of information from periphery to brain
• The information that travel faster have higher priority to pass the gate and arrive at brain
4. Hydrodynamic Theory
• Provides explanation for dentinal pain and sensitivity
• Dentinal Sensitive is caused by direct stimulation of sensory nerve ending in the dentin which are primarily located near the pulp
• Yet the most sensitive part of the tooth is at DEJ where no nerve endings exist
• Hydrodynamic theory suggest that the nerve endings near the pulp are stimulated due to the movement of dentinal fluids present in dentinal tubules
Classification of Pain
• Acute pain:
• Sudden onset, 1st pain
• Sharp, localized and throbbing
• Information carried through A delta fibers which are large and thinly myelinated neurons (100m/s)
• Chronic Pain:
• Long lasting pain
• Dull and aching pain
• Information carried through C – fibers which are small and unmyelinated neurons ( 0.5-2m/s)
Pathway of Pain
• Describes how a certain stimuli can travel from periphery ( skin or tooth) to brain and be interpreted as pain
• Most of painful stimuli in dentistry are mechanical (a stimuli that causes physical injury to tissue) and can be further aggravated by inflammation and its chemical modifiers
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