Pain control during nonsurgical periodontal therapy

Nonsurgical approaches such as scaling and root planing are routinely used to prevent or treat periodontal diseases. However, fear of pain and discomfort during subgingival instrumentation has been reported to deter nearly 10% of the population from seeking treatment. The degree of periodontal pain experienced by the patient is influenced by several factors, including amount of inflammation, depth of the pockets, and location of the disease. Thus, timely elimination of inflammation is important not only in treating the disease but also in preventing or controlling pain. Mechanical instrumentation of the subgingival environment commonly is used in the initial treatment of the disease, as well as during periodontal maintenance. Traditional methods for pain control during these procedures have included local anesthesia administered through injection, which in itself is a significant source of discomfort. Certain recently developed drug delivery systems show considerable promise as adjuncts to injection-based local anesthesia and in some cases provide alternatives. Prevention of pain before its initiation or before transmission of nociceptive information is known to be safer and more effective than attempts to minimize pain after it begins. This article reviews the transmission pathways of periodontal pain and discusses some of the current strategies to control pain during periodontal examination and nonsurgical periodontal therapy.