Michael Sultan: Pain and Dentistry

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EndoCare's Dr Michael Sultan considers the relationship between pain, emotion, and dentistry

Recently, scientists from Duke University in America, discovered that sensory neurons from the teeth and face are wired directly to one of the brain’s principal emotional signalling hubs, while sensory neurons from the body are connected only indirectly. Pain signals from the head versus those from the body are carried to the brain through two different groups of sensory neurons, and it is thus possible that neurons from the head are simply more sensitive to pain than neurons from the body are [1].

This may explain why toothache is considered one of the worst pains and causes so much physical and emotional suffering, especially when compared to other injuries or ailments. Indeed, the research also suggested that these pain groups which were directly connected to the facial area activated the brain's emotional centres more dramatically than elsewhere.

In practice, this means that we, as dentists, should not simply be focusing on the treatment of our patients' pain, but responding to the emotional aspects of that pain as well. Of course, the majority of patients will only be concerned with the removal of the pain – that's what they primarily come into the practice to have solved. And while we should adhere to our patients' wishes and do everything we can to safely and efficiently provide a solution, we should also be mindful of their emotional response – not only to the pain, but to the solution too.

Self esteem

After all, teeth are crucial to our self-esteem and self-image – and if the treatment we have proposed to remove their pain comes at the cost of extracting a tooth, then we have to help patients deal with this decision. Similarly, as we all know, dental treatment can cause incredible anxiety in patients – exacerbated by pain – and we must use all of our skill and expertise (not to mention our professional empathy) to help patients deal with these insecurities.

Another important aspect of dealing with the emotional response to dental pain and palliative treatment is aftercare. Even with relatively routine treatments, it is important to communicate with patients throughout the healing stage – even if it is simply to reassure them that everything is OK.

Sometimes it is easy to forget, especially after hundreds of cases, that the patient might not realise that something we would recognise as normal is such. They might not realise that the ache or pain they are experiencing is part of the typical healing process and is nothing to worry about.

The research done by the team at Duke University, while certainly an enlightening look into the neurological responses to dental and facial pain, is more useful to us as a reminder to consider all aspects of our patient's reaction to toothache – and can be used to provide our patients with a better, more empathetic service in the future.

Author
Dr Michael Sultan is the founder of EndoCare, one of the UK’s leading specialist endodontic practices. For more information call 020 7224 0999 or visit www.endocare.co.uk 

Reference
1] Dental Tribune: Toothaches: Why head and facial pain cause particular suffering. Link: click HERE