Dental clinics of North America
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Opioid analgesics continue to be the most important drugs in modifying the response to pain. Their versatility is attested by their frequent use in both postoperative and intraoperative management of pain. Recent findings regarding the mechanism of action of opioids may signal the introduction of newer, more effective, and less addictive agents. ⋯ The adverse effects of nausea and dysphoria and the more serious effects of respiratory depression continue to be a problem, as does the possibility of abuse. Nonetheless, the clinical experience with opioids in control of pain is uncontested. Until better drugs are developed, opioids will form the basis for the control of acute pain by the dental practitioner.
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Local anesthetics are the most widely used drugs in dentistry today. Knowledge of the pharmacology and toxicology of these agents will result in their intelligent and judicious use. The choice of local anesthetic should be individualized for each patient. ⋯ Occasionally, a clinician may be unsuccessful at achieving regional anesthesia despite these additional measures. Highly anxious dental patients or patients with a genuine tolerance to local anesthetics normally pose the most problems. Transitional block or threshold block phenomena should also be suspected in these situations.(ABSTRACT TRUNCATED AT 400 WORDS)
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The clinical usefulness of a drug therapy program for the management of chronic head and neck pain requires an understanding of the conditions in which the program will be used. The practitioner should remember that drug therapy is not the keystone of chronic pain management, but only a useful adjunct that should be eliminated or reduced as soon as feasible. The other various modalities for chronic pain management, which include physical therapy, relaxation therapy, transcutaneous electrical nerve stimulation, injection therapy, and occlusal reconstruction should be utilized to their fullest extent if the patient is to achieve success.