Acute Versus Chronic Dental Pain During COVID-19

During this time, while we are working through COVID-19 in our dental practices, some of you are helping patients in need of emergency dental care. One of the “urgent care” challenges we all cope with during normal practice applies during Coronavirus…and maybe in a new way. This challenge is helping patients understand the dental pain they are experiencing and what we can do to address it.

Acute Pain

In dentistry, we are accustomed to dealing with patients who have pain. The majority of the time it is acute odontogenic pain. With acute pain, patients seek diagnosis and treatment promptly, reporting that the pain is intolerable and getting in the way of their normal function. When patients seek diagnosis and treatment promptly, standard treatment modalities more predictably eliminate the pain.

Chronic Pain

However, in the case of chronic pain, when patients are not experiencing an intolerable level of pain and have found ways to function around it, or when the pain is intermittent coming and going over a period of months and patients have not promptly sought help, we have a greater challenge. This is because, when pain occurs constantly or intermittently in the same location for more than 90 days, the neurological system tends to rewire itself. Now, when we treat the original source of the pain with standard modalities, we may not get a satisfactory pain elimination result. The pain has become the diagnosis itself. It has become a pain disorder.

Listening to what the patient tells us, helps us understand whether the pain is acute or chronic. In the case of chronic pain, patients have suffered with it for months and typically report attempting to figure out the source themselves and holding on to the ope that it would just go away. They may have been to more than one clinician seeking a diagnosis. Perhaps, they have had treatment and pain has persisted.

Communication is Key

We need to communicate to our patients that we want to diagnose and treat pain before it becomes chronic and that, once the pain has persisted for more than 90 days, it becomes a diagnostic and therapeutic challenge. As we enter the second phase of COVID-19, I have communicated with my own patients that I can see them for urgent care and to please call me if they are in acute pain. We can perform standard treatments for emergency dental needs at this time.

The message for chronic pain sufferers is more challenging. If their lives have become so disrupted that they cannot normally function, I want to help them and can do a teleconference consultation during which we talk about the history of the pain, I help them understand the nature of chronic pain, and we discuss how we can partner now remotely in finding a pain management strategy and later partner in my normal clinical setting.

The relationship we create with our patients, during this time, may be more binding than ever before. Treat these relationships like the most prized jewels.

Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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