Dental Tribune United Kingdom Edition

FenderMate® is a trademark registered by Directa AB. Registered Design and Patent pending. Mimics natural contour Flexible wing exerts pressure for maintained separation and cervical adaption Inserts like a wedge Compressing wedge mimics natural separation and prevents overhangs World’s Fastest Composite Matrix? 3216-1009©DirectaAB Matrix Distributed in the UK by Trycare, Tel. 01274-88 10 44 More Designs by Dentists www.directadental.com April 25-May 1, 2011United Kingdom Edition T he International As- sociation for the Study of Pain (IASP) selects a different, pain-related issue to study each year. 2011 has been designated as the ‘Global Year Against Acute Pain’ with the fo- cus on raising the levels of un- derstanding and the quality of treatment for acute pain in all its forms. A natural consequence of medical advances in the con- trol or subjugation of previ- ously life-ending diseases and trauma repair is greater lon- gevity for the victims. With average life expectancy for all of us rising, the importance of research into pain management and its effects on the individu- al’s quality of life is axiomat- ic. While few people actually die of pain, many lives are blighted by a failure to reduce or understand its debilitating effects and how destructive it can be for the individual, particularly over an extended period. Acute pain should not be confused with chronic pain. Acute pain, by definition, is spasmodic in nature and rela- tively short lived, while chronic pain, however intense, is con- tinuous. Acute pain develops when the brain receives sudden notice of tissue damage, and the nerve signals are amplified by sensitisation in the central and peripheral nervous systems. Although the incidence may be brief, repeated occurrences quickly disrupt the quality of daily life and without treatment can develop into a condition of chronic pain. Pain by its very nature is subjective; pain ‘thresholds’ vary hugely between genders, ages and cultures, and the in- tensity of physical pain can also be affected by psychological and emotional factors. Compar- isons between individuals suf- fering from very similar condi- tions are therefore rarely of any value and can be offensive to the sufferers. The priority for every clini- cian should be the immediate reduction of acute pain, both to relieve the sufferer and to prevent the onset of chronic pain. However, the situation is often not as simple as it seems. An IASP1 report has found that many healthcare professionals have a tendency to downplay the importance of acute pain management for a variety of reasons. Reasons include a be- lief that pain relief medication may mask symptoms or impede curative medication, or that the patient should in any event ex- pect, and therefore tolerate, a certain amount of discomfort. This lack of education in the practitioner may be mirrored in the patient, who fears be- coming addicted to palliatives, or that taking pain killers may have side-effects, or perhaps delay recovery. With both par- ties experiencing uncertainty, acute pain is all too often under assessed and under treated. It is my own contention that as healthcare profes- sionals compassion is inte- gral to our responsibilities and we have a duty to be fully aware of the nature, treat- ment methodology and po- tential consequences of acute pain. Within dentistry, endodon- tics is an area where practition- ers should pay particular atten- tion to this aspect of patient care by keeping up to date with the latest information and tech- niques for pain management. The problem needs to be ad- dressed on three fronts – by individual practitioners, their colleagues and by the patients. Traditionally, dental and en- dodontic practices’ professional promises of intent have been al- truistic, vague, and expressions of the obvious in bland, Quix- otic language. Announcing a goal of delivering the best pos- sible care in the best possible environment is neither binding on the clinician nor reassuring for the patient. I suggest that our mission statements should be rewritten to imply a greater sense of imperative, obligation and urgency – for example: It is the absolute right of every patient to be free from pain, and we as endodon- tists will take every possible measure to protect and promote a higher quality of life for all our patients. Once we have made our own commitment to expand our knowledge, we can progress to spreading the word amongst our colleagues about the opti- mum application of anaesthesia and analgesics in the resolution of the pain associated with ex- treme dental disease or tooth restoration. Increased aware- ness among practitioners will in turn enable more patients to be properly advised on the appropriate control of post- treatment pain, and so overall standards of care will rise. A key issue in endodontics today is the cost of treatment, which was recently highlighted by the Steele report2 . The relief of pain by tooth preservation or root canal treatment is be- yond the means of many, with a huge, less well-off demographic obliged under the NHS to ac- cept extractions or removable prosthetics as the only alterna- tives. I do not believe this is ac- ceptable in an advanced society in the 21st Century, and dental professionals need to liase with the Government to allow access to the private sector for NHS endodontic patients. The diagnosis and treat- ment of acute pain has been too long neglected at worst and un- der addressed at best, and the IASP is rightly determined with its ‘Global Year Against Acute Pain’ to draw attention to our professional shortcomings in this area. DT Phantom thresholds Michael Sultan discusses pain control References: 1 Global Year Against Pain Fact sheet Why the Gaps between Evidence and Practice? http://www.iasppain.org/Content/Naviga- tionMenu/GlobalYearAgainstPain/Globa- lYearAgainstAcutePain/FactSheets/default. htm (accessed 03/02/2011) 2 http://www. dh.gov.uk/en/Healthcare/Primarycare/ Dental/DH_094418 page 57ff. (accessed 03.02.2011) About the author Dr Michael Sul- tan BDS MSc DFO FICD is a specialist in Endodontics and the Clinical Direc- tor of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before com- mencing specialist studies at Guy’s hospital, London. He completed his MSc and in Endodontics in 1993 and worked as an in-house endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lec- tured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. In 2008 he became clinical director of EndoCare - a group of specialist practices. For further information please call Endo- Care on 0844 893 2020 or visit www. endocare.co.uk ‘A natural consequence of medical advances in the control or subjugation of previously life-ending diseases and trauma repair is greater longevity for the victims’