News From The Dental Profession

By Author: Steven Johnson
Total Articles: 490
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For many people, it's easy to forget pain is not just a medical problem in the sense you see a doctor. Dental problems can cause severe pain and the management of that pain is a matter for the dentist. This does not mean the two professions are independent. There's no reason why one cannot learn from the other. Pain is pain no matter what the cause.

Let's start with a slightly unusual gender difference. For most practical purposes, there's no physical difference in the way the sexes respond to pain. There may be cultural differences with the macho males being less willing to admit feeling pain but, once the messages from the nervous system reach the brain, we all feel pain in the same way. Except the research team at the University of Washington has discovered that the pain associated with some dental conditions changes through the menstrual cycle. It seems the pain grows increasingly severe, reaching its peak during ovulation, and then declines as the hormone levels fall. This led some dentists to believe the pain could be managed through the use of oral contraceptives. The results of a recent trial have now been published. ...
... Researchers recruited a group of women with the same dental problem. They were divided in unequal groups. One received oral contraceptives intended to stabilize the hormone levels. The other two received different types of advice. One was specific to the management of pain associated with the menstrual cycle. The final group received a more general cognitive behavioral therapy designed to help them manage all their pain.

There was follow-up at six and twelve months. At both points, the groups receiving continuing support for pain management reported significant improvement over the contraception group. There was no measurable difference in response between behavioral therapy specific to the menstrual cycle and the general advice. It seems any regular contact between patient and a trained therapist is beneficial when combined with literature to teach self-management techniques. This exactly matches the results of comparable studies carried out into the effectiveness of "medical" cognitive behavioral therapy both in the US and the rest of the world. There's a mountain of evidence that all patients respond well to continuing personal support in the community. All it takes after training sessions is regular telephone contact with a trained therapist offering encouragement and practical tips. All people report a reduction in pain through their own efforts.

This is not to deny the use of a drug therapy may be effective in the short term. Indeed, the sole point of the research into the use of oral contraceptives was to test whether the use of a freely available drug might reduce dental pain. That there was no measurable reduction in pain was a "good" result. It suggests more work needs to be done on proving the exact link between the hormone fluctuations during ovulation and sensitivity to pain. It's entirely possible this work will lead to more general benefits in both the medical and dental fields. While we wait for the results, using Tramadol for pain relief is the standard option if cognitive behavioral therapy is not available or affordable. In the short-term, Tramadol will eliminate the pain.