Universitat Internacional de Catalunya - Barcelona

Pain Control in Endodontics.

• code 11447
• course 2
• term Anual
• type OB
• credits 4

Main language of instruction: English

Other languages of instruction: Spanish

Head instructor

Dr. Jordi TOMÀS - jtomas@uic.es

Office hours

MSc Jordi Tomàs Aliberas -jtomas@uic.es

Anaesthesia, pain control and anxiety in dentistry are very important factors in the clinical dynamics of the endodontist.

This subject aims to instruct the student in the manipulation of the anaesthetic material, safeguarding aseptic principles, knowledge of the drugs used and mastery of the main techniques, as well as the systemic considerations of the patient. The knowledge imparted will help reduce the patient's anxiety and perform endodontic treatments with the absence of pain.

Knowledge of anatomy, physiology and pharmacology.

To learn the origin of odontogenic pain and its pathways of propagation.

To be familiar with the general pathological characteristics of the illnesses and disorders that affect organic systems, specifically those which have dental repercussions.

To provide the student with the theoretical, anatomical, physiological and pharmacological bases necessary for the control of pain.

To understand and master the locoregional anaesthesia techniques most frequently used in dentistry.

To know about all of the possible complications and to master how to treat them, as well as understand the limitations of local anaesthesia.

To know the guidelines for the pharmacological treatment of pain.

To train students in the correct manipulation of their instruments and material through a sterile and safe technique.

To train students to decide the appropriate anaesthesia technique for each patient and planned treatment.

To train students in the clinical use of analgesic drugs, personalising the therapeutic guidelines for each patient.

Students will be expected to:

• Know the protocols of action in the case of the pain before, during and after an endodontic treatment.
• Know the interactions of the medication and pathology of the patient prior to undergoing endodontic treatment.
• Perform the correct anaesthesia, anti-inflammatory or antibiotic procedure to combat pain of endodontic origin.
• Share information with other health professionals and work as a team.
• Know about the general processes of the disease, including infection, inflammation, irregularities in the immune system, degeneration, neoplasia, metabolic changes and genetic disorders.
• Know, critically evaluate and use the sources of clinical and biomedical information to obtain, organise, interpret and communicate scientific and healthcare information.
• Obtain and compile a medical record containing all relevant information.
• Know the scientific principles of sterilization, disinfection and antisepsis necessary to prevent cross-infection in dental practice.
• Recognise both oral normality and pathology, as well as to assess semiological data.
• Know the general pathological characteristics of the diseases and disorders that affect the organic systems.
• Know the oral manifestations of systemic diseases.
• Know the pharmacological bases of the different local and general anaesthetic techniques, as well as the role of sedation and general anaesthesia in the management of dental patients.
• Know and to handle the medical emergencies most frequent in dental practice and in the techniques of basic cardiopulmonary resuscitation.
• Issue appropriate drug prescriptions, knowing their contraindications, interactions, systemic effects and repercussions on other organs.
• Know how to identify the concerns and expectations of patients, as well as how to communicate effectively and clearly, both orally and in writing, with patients, family members, the media and other professionals.
• Apply locoregional anaesthesia techniques.
• Know how to apply the correct principles to control anxiety and stress in oneself, in patients and in other members of the dentistry team.

The knowledge acquired in this subject should enable students to use rational anaesthetic drugs and anti-inflammatory analgesics, depending on the characteristics and conditions of each patient according to the different stages of their endodontic treatment. In the same way, they should be trained to correctly perform the different techniques of local and locoregional anaesthesia of the oral cavity. They should also provide a reassuring attitude towards the patient in order to reduce their anxiety.

Students will be expected to:

Identify the most relevant characteristics of the different drug groups: pharmacological activity, mechanism of action, indications, doses, contraindications and adverse effects.

Use the information sources of pharmacology.

Understand the pathophysiology of odontogenic pain.

Obtain and compile a medical history that includes all relevant information.

Perform a general physical examination and record vital signs.

Master the techniques of locoregional anaesthesia in the oral and maxillofacial region.

Know how to treat complications arising from locoregional anaesthesia.

1. Anaesthetic techniques according to:
The pulpoperiapical diagnosis.
The degree of severity of pain.
The systemic conditions of the patient.

2. Indications and contraindications of anxiolytic, anti-inflammatory and antibiotic premedication. Dosage, form of dosage and systemic interactions.

3. Knowledge of the main systemic diseases that can affect our treatment.

4. Knowledge of the patient's medications and their interactions with endodontic treatment.

5. Management of intra-operative pain: Complications during treatment (extrusion hypochlorite, drain purulent exudate).

6. Pathophysiology of postoperative pain. Study of mediators of inflammation and tissue response.

7. Management of postoperative pain: Guideline for action in exacerbations (flare-up). Guideline medication, therapy and surgery.

8. Differential diagnosis between periodontal and pulpal-based pain.

9. Non-odontogenic-based pain: ATM - Muscular - Neurologic.

10. Guideline for action in paediatric patients.

The student must attend and present an oral communication at two national conferences (AEDE or SEOC) and at an international congress (ESE or AAE).

Student participation at seminars.
Examination of 25 short questions. A mark of 60% is required to pass the exam. The final grade is based 75% on the exam and 25% on participation in seminars.

Papers from JOE and IEJ related to the subject.

Cohen S, Burns RC. Pathways of the pulp. 10th ed. St. Louis: Mosby, 2011

Gutmann JL and cols. Problems solving in endodontics. Prevention, identification and management. 5th St Louis: Mosby, 2012.

Ingle JI, Bakland LK. Endodontics. 6th ed. McGraw-Hill, 2008.