PerioVive in Practice: Pain Management in Dentistry

Pain management in dentistry is an essential component of all dental procedures. For maximum efficacy pain management should be utilized pre-, intra- and post-operatively. It is important to use multi-modal pain control that addresses various points in the pain pathway and targets specific anatomic regions. This approach reduces the need for high doses of single analgesics and achieves superior analgesia with fewer side effects.

Classes of analgesics used in veterinary dentistry include:

1. Systemic

   Opioids - provide the most effective analgesia and can be used in all three phases of the dental procedure in dogs and cats. Examples: Morphine, Buprenorphine, Methadone, Fentanyl, Codeine.

   
   

   NSAIDs (non-steroidal anti-inflammatory drugs) - Cox-2 (cyclooxygenase) enzyme inhibitors control pain by reducing inflammation. Example: Carprofen, Deracoxib, Firocoxib, Grapiprant.

   
   

   Alpha2 agonists – when used in combination with opioids can provide effective sedation and analgesia but common physiologic side effects include bradycardia, respiratory depression and vomiting.  Example: Dexmedetomidine.

   
   

   NMDA (N-methyl-D-aspartate receptor) antagonists – act by attenuating central sensitization to pain. NMDAs do not provide adequate analgesia alone but can be effective when combined with an opiate or NSAID. Example: Ketamine, Amantidine, Dextromethorphan)

2. Local/regional 

   Sodium channel blockers - used in dental nerve blocks to decrease pain perception and central sensitization. This enables a lower amount of inhalant anesthetic while providing intra- and post-operative pain control.  Example: Lidocaine, Bupivicaine, Ropivacaine.

3. Adjunct treatment

   Hyaluronic acid – PerioVive is a hyaluronic acid gel that is applied topically at the conclusion of dental procedures to decrease pain and inflammation, and accelerate the rate and quality of tissue healing. Pain control is achieved through several mechanisms including, decreasing mechanical sensitivity of stretch-activated ion channels to block the pain response, interacting with HA receptors and/or free nerve endings to block the transmission of pain impulses, decreasing PGE₂ and bradykinin (BK) synthesis, and inhibiting substance P.

   
   

   Laser therapy - Class IV laser treatment (photobiomodulation) uses deep-penetrating infrared light to stimulate cellular metabolism. When used following dental procedures it increases circulation and reduces recovery times. Hyaluronic acid, the active ingredient in PerioVive works synergistically with photobiomodulation to maximize the anti-inflammatory and analgesic effects.

Using PerioVive in dentistry practice can offer significant pain management and enhanced tissue healing benefits by reducing inflammation, supporting tissue regeneration, accelerating recovery, and improving overall patient comfort following dental procedures.

References

Beckman, B. Analgesics for oral surgery in dogs and cats. DVM 360 November 1, 2007

Mulherin, B and J Riha. Regional Anesthesia for the Dentistry and Oral Surgery Patient. TVP. Dec 7, 2018.Issue Jan/Feb 2019. https://todaysveterinarypractice.com/category/january-february-2019/

O'Morrow C. Advanced dental local nerve block anesthesia. Can Vet J. 2010 Dec;51(12):1411-5.

Pena Ede L, Sala S, Rovira JC, Schmidt RF, Belmonte C. Elastoviscous substances with analgesic effects on joint pain reduce stretch-activated ion channel activity in vitro. Pain. 2002;99(3):501–508.

Yilmaz, N; et al. The Efficacy of Hyaluronic Acid in Postextraction Sockets of Impacted Third Molars: A Pilot Study. Nigerian Journal of Clinical Practice 20(12):p 1626-1631, December 2017. 

Yakout BK, Kamel FR, Khadr MAEA, Heikal LAH, El-Kimary GI. Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial. BMC Oral Health. 2023 Oct 27;23(1):805.