Pain and Pain Control

Pain in the orofacial area is the most common reason for the patients to visit a dentist. We also know that approximately 10 percent of various pain conditions in general are found in the head including the orofacial area. Moreover, if pain in the neck and shoulders were added with the orofacial pain, it will altogether make close to one third of all clinical pain conditions. Accordingly, dentists must have a good knowledge regarding both the diagnosis and treatment of not only the endodontic emergencies but, in addition, a number of orofacial and related pain conditions. The dental curriculum for students contains a considerable amount of teaching related to the subject. However, we must admit that our knowledge considering various pain conditions is far from sufficient. One very basic reason is that the pathophysiological mechanisms and, accordingly, the treatment of various pain conditions vary to a great extent. Therefore the diagnostics of the patients pain is extremely complicated and demanding, sometimes even frustrating.

The treatment and prevention of acute dental pain is covered in the dental curriculum. Accordingly, dentists are expected to master well the treatment of pulpal and apical pain due to bacterial induced inflammation including trauma and postoperative conditions. Even though claimed as being "simple" and basic dental interventions, nociceptive pains can in some cases be quite demanding. Therefore, the knowledge of adding effective medications as well as also local anesthetics is important for the treatment of odontogenic pain. However, a complete overview might be difficult to reach within the curriculum where weekly acute pain is difficult to order equally for each student.

Additionally, various chronic orofacial pain conditions, e.g. neuropathic pain, should be more extensively covered in the dental education. Those include different types of oral mucosal pains, such as burning mouth syndrome, TMD-related pain, both in the masticatory muscles and the temporomandibular joints, different types of headaches, etc. Maybe the most important and demanding issue related to those various pain conditions is the diagnostic capabilities of the dentist because the treatment must always be based on a proper diagnosis. Much effort would be needed to reach sufficient skills, especially in the diagnostics of the various orofacial pain conditions but also in different types of treatment. As already mentioned orofacial pain is common but the amount of personnel specialized in the treatment of pain patients, is certainly insufficient. Accordingly, it would be beneficial if at least part of the pain patients could be treated (and especially diagnosed) at the basic clinical level.

It should always be kept in mind that acute pain may change to chronic within a few months if it is not effectively treated. Today the dentists have sufficient tools for prevention of pain that could develop to chronic. Eight articles related to various orofacial pain conditions are included in the present Nordic Theme 2016 "Pain and Pain Control". It is evident that the articles can´t cover all problems that a dentist will meet daily in the clinical practice but hopefully, this Theme will open the eyes and help to realize how huge a pain problem can be and how important it is to early start to treat the patient's pain problem. Last but not least, this Theme will also help to realize how much more we would need to know in order to be able to properly help our pain patients and that such knowledge should be included in the dental curriculum for the students.

Coordinators of Nordic Theme 2016