AUTHOR:

Dr Shreyank Kotian, BHMS (Intern), Father Muller Homoeopathic Medical College under the guidance of Dr Skandhan. S. Kumar, Assistant Professor, Organon of Medicine- Father Muller Homoeopathic Medical college and Hospital Mangaluru.

ABSTRACT:

BACKGROUND: The sole and raised mission of the doctor is to restablish the health of the sick, which is called cure same holds true for a Dentist also. Homeopathy is the second largest system of medicine in the today’s world recognized by the World Health Organization. It is an emerging field of dental medicine that is useful in management of conditions affecting orofacial structures Homoeopathically. This article explains in detail different types of pain & its expressions as well as how we can manage it Homoeopathically.

KEYWORDS: Homoeopathy, Dental, Health, Management, Awareness.

1. INTRODUCTION

As our master Dr Samuel Hahnemann, had said “The most inestimable treasures are: impeccable consciousness and good health. Love to God and self-study provide one; homeopathy provides the other” this statement holds good even in case of Dentistry. Homeopathic remedies can be used in many ways, in both the conditions before treatment and also after dental treatment. They can drastically reduce anxiety before a visit to the dentist especially in children’s, reduce the tendency towards any damage during procedures, and relieve pain afterward.

Dental pain is one of the most troublesome conditions, physically and psychologically, seen in individuals of all ages, especially with regards to its effect in hindering the day to day activities. Studies show that about 15.6% ⁽¹⁾ of school going children are suffering with dental pain of various causes out of which 66% ⁽¹⁾ of those suffering have complained of its impact on daily activities.

International association for the study of pain defined pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” ⁽²⁾   Consideration of both motivational-affective that is the unpleasantness of the pain and the sensory-effective component of pain that is the intensity of pain⁽³⁾ becomes important. Homoeopathic individuality of different types and effects of pain can be determined by understanding these factors and applying accordingly.

Nociception ⁽⁴⁾ is the detection and signaling of the presence of a noxious agent which may be present or absent which becomes important in homoeopathy to remove any substance that acts as a maintaining factor.

We need to understand that the intensity of pain not only depends upon the cause of the symptom but also the amount of attention the individual has on the sensations. In short the mental state of the patient.

We often see the variations of pain that changes from individual to individual .This only suggest that the neural mechanisms that transmits pain ,modify the individual’s emotional experience of pain.

Hence it is only just to conclude the pain in the oral cavity as not only a static process involving exclusive pathways ,that is, from the peripheral tissues through the spinal cord to the brain ,but it is more of an interplay that occurs between the excitatory and inhibitory neuronal systems as a multiple level of the CNS.

1.1 The pain may be described in three ways ⁽⁴⁾

1. Acute pain
2. Inflammatory / neuropathic pain
3. Chronic pain

The following headings will be described based on a general characteristics of pain, the oral and maxillofacial pathology and the Homeopathic therapeutics of the same.

2.ACUTE PAIN

This type of pain is generally associated with the cause-effect relation which is generally easily available. Usually seen following injury or surgery. Dental injuries are commonly seen in children when compared to adults which may be a result of fall or physical external impact

Some of the basic injury seen in both primary and secondary teeth are ⁽⁴⁾

1. Concussion-damage to the periodontium due to traumatic event without displacement of

2. Subluxation-damage to the periodontium with losing of teeth but no displacement

3. Luxation-dislocation of tooth in its socket

4. Avulsion – completely displaced from the socket

2.1 Dentistry management ⁽⁵⁾

• In children for primary tooth generally includes application of soft diet
• Restoration procedures as per necessity or when root canal procedure are indicated.
• Extraction of the tooth if the injury is responsible for crown mobility. In cases of intrusion, that tooth may be left to erupt.
• Extraction of the tooth may be necessary if either intrusion involves permanent follicle as per radiograph or if the exclusion is more than or equal to 2 millimeter.
• In cases of evolution, it should be left and no replantation should be done.
• In cases of permanent teeth soft that is a general treatment irrespective of cause. Fracture of the tooth may attract various types of procedure depending on the involvement of structures on the level of depth of fractures.
• Protection and restoration of dentine, pulpotomy, pulp cap, and pulpectomy are some of the common procedures done.

2.2 HOMOEOPATHIC TREATMENT ^{(6, 7, 8, 9,12)}

The general treatment of appropriate cleansing and maintaining the hygiene of tooth and intake of soft food / liquid food is an undeniable suggestion to be given to every patient.

Remedies that are indicated for pain includes

• Pain after extraction of teeth

 Arnica, Staphysagria, Sepia

• Pain on biting

 Aesculus, Alumina, Bryonia, Guaj, Hepar Sulph, Mercurious, Mezerium, Staphysagria

• Pain due to broken tooth

 Euphrasia, Natrum Mur, Plumbum Met, Sulphuric acid

• Teeth pain leading that leads to fainting

 China, Pulsatilla, Veratrum Alb

2.3 REMEDIES BASED ON LOCATION OF PAIN ^(7,8,12)

2.4 REMEDIES BASED ON TYPE OF PAIN  ^{(6, 7, 8, 9, 10, 11, 12)}

ACHING	BURNING	DRAWING/ JERKING	BORING	SHOCK LIKE	STITICHING	THROBBING
Cham Kreos Merc Mez Staph	Arsenic Belladonna Silicea	Bell Cham Chemop Merc Nux V Puls Spig	Calc C Carb V Mezereum Nux V Silicea Staphy	Am.C Arania Nux, V	Bryonia Chamomilla Nit Ac Pulsatilla	Bell Cocc Merc Silicea Acon

                        

3. INFLAMMATORY OR NEUROPATHIC PAIN

Inflammatory pain is associated with peripheral tissue damage whereas neuropathic pain is result of CNS dysfunction such as post herpetic neuralgia or trigeminal neuralgia.

Both inflammatory and neuropathic pains are characterized by changes in sensitivity

ALLODYNIA-PAIN, even on removal of stimuli that initiate pain

HYPERALGESIA-exaggerated response to a noxious stimuli ⁽⁵⁾

3.1 Some of the causes of inflammatory pain are

• Acute Pulpitis
• Acute Periapical Periodontitis
• Hypercementosis
• Pericoronal Inflammation
• Acute Alveolar Abscess
• Actinomycosis
• Acute Osteomyelitis

3.2 HOMEOPATHIC THERAPEUTICS ^{(6, 7, 8, 9, 10, 11, 12)}

• Neuralgic, congestive (See Odontalgia.) — Acon., Aran., Ars., Bell., Ced., Cham., Coff., Dolichos, Ferr. Picr., Ign., Mag. C., Mag. P., Merc. V., Plant., Spig.
• Inflamed Dentine – MERC
• Abscess– Bar-c , Hecla, Lyco, Merc, Hep, Sil
• Caries in children– Calc, Calc-F , Fl-ac, Kreos, Staphy
• Periodonits (Rigg’s disease) — Calc. Ren., Merc., Sil. Mar.

3.3 Remedies for Hyperalgesia

• Coffee — Cham., Ign
• Tea — Thuya.
  Tobacco-smoking — Clem., Ign., Plant., Spig
• Beer– Nux V , Rhus T, Zinc

4. CHRONIC PAIN

            Chronic pain is not called so due to the amount of time the patient suffers from pain but depending on the inability of the body to restore its physiological functions to normal homeostatic levels.

Pain persisting beyond the normal time of healing of an injury and its intensity .There is no relation to the extent of tissue damage or without an identifiable cause.

Some of the common causes of chronic dental pain with its homoeopathic therapeutics are as follows

• CHRONIC PULPITIS

Infiltration of the pulp with lymphocytes and their derivatives and macrophages which may spread into the peri apical tissues. General treatment for chronic pulpitis is endodontic therapy, extraction of the affected tooth, pulpectomy.

Homoeopathic remedy- Belladonna

• CHRONIC PERIAPICAL GRANULOMA

Formation of granulation tissue surrounding effects of tooth which presents with few or no symptoms. Endodontic therapy / extraction is the common treatment. Apicectomy is only done if lesions persist.

Homeopathic remedies- Echin , Mur-Ac, Rhus Tox, Silicea⁽⁶⁾

• Chronic infections of face such as maxillary infections, mandibular infections, cellulitis, cavernous sinus thrombosis. This is usually seen after an acute treatment is inadequate

• Formation of a persistent sinus for meeting intermittent discharge of pus is seen in this condition.

Homeopathic remedies- Calc-F, Caust, Fl-Ac, Nat-M, Sil, Staph, Silicea ⁽⁸⁾

• CHRONIC OSTEOMYELITIS

Acute osteomyelitis naturally progress to the chronic stage when there is accumulation of pus with the islands of sequestrum. Predisposing factors includes immunosuppressed states, diabetes mellitus, long standing corticosteroid use, Paget’s disease

There is less severe pain and swelling but enlargement of the bone with one or more soft-tissue sinuses with draining pus is seen in this condition

Homeopathic remedies- Cham, Kreos, Merc , Mezerium, Staph

• GARRE’S OSTEOMYELITIS

Chronic sclerosing osteomyelitis with proliferative periostitis associated with chronic periapical periodontitis or chronic pericoronitis

Formation of periosteal bone which is tubercular in nature with onion layering of reactive bone is characteristic

Homeopathic remedies- Calc P, Iod, Merc-i-r, Phos, Silicea

• OSTEORADIONECROSIS

Reduction in vascularity, secondary to endarteritis obliterans and damage to osteocytes as a consequence of ionizing radiation therapy. Here, ear bone may be cavitated and discoloured with sequestrum and acute inflammatory infiltrate may be present on the background of chronic inflammation. Blood vessels shows area of endothelial denudation

Here the patients who require radiotherapy for management of head and neck malignancy should ideally have the teeth of doubtful prognosis be extracted 6 weeks prior treatment, that is, pre radiation extraction. Healing depends on age and stage of disease

• PERIOSTITIS is seen as a result of chronic irritation to the periosteum from a foreign material that enters to an ulcer ,that is, from grains vegetables or by ill-fitting denture

Homeopathic remedies- Asaf, Aur-Met, Aur-Mur, Guiac, Kali-B, Kali-Iod, Merc- S, Mez, Nit Acid ^{(6, 7, 8, 9)}

5.REMEDY SELECTION BASED ON TEMPERATURE MODALITIES⁽¹³⁾

We generally notice the sensitivity of teeth and the surrounding structures associated with modalities of heat and cold. The following table given by Dr A C Dutta simplifies the process of arriving at a final remedy using modalities of temperature.

CONCLUSION:

Changes that come to material substances, specially the medicinal, through the trituration of non-medicinal powder, agitation of non-medicinal fluid, are so incredible that may be compared to miracles, and is a reason of joy that those changes belong to Homeopathy but this system is not completely used in the field of dentistry, so here in this article its an attempt to create awareness regarding the same and get our system into light so that its scope in dentistry can also be utilised for treating the needy. And as a conclusion I would like to say that One of the natural methods of healing available to dentists is homeopathy, a system that utilizes a person’s basic healing properties to achieve optimum health.

BIBLIOGRAPHY

1. Saheer a, kousalya ps, raju r, gubbihal r. Dental pain among 10–15 year old children attending oral health promoting schools: a cross-sectional study. Journal of international society of preventive & community dentistry. 2015 dec;5(suppl 2):s101.
2. Raja sn, carr db, cohen m, finnerup nb, flor h, gibson s, keefe fj, mogil js, ringkamp m, sluka ka, song xj. The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain. 2020 sep 1;161(9):1976-82.
3. Auvray m, myin e, spence c. The sensory-discriminative and affective-motivational aspects of pain. Neuroscience & biobehavioral reviews. 2010 feb 1;34(2):214-23.
4. Coulthard p, horner k, sloan p, theaker ed. Master dentistry e-book: volume 1: oral and maxillofacial surgery, radiology, pathology and oral medicine. Elsevier health sciences; 2013 may 24.’
5. Heasman p. Master dentistry e-book: volume 2: restorative dentistry, paediatric dentistry and orthodontics. Elsevier health sciences; 2008 aug 26.
6. Boericke W. Pocket manual of homeopathic materia medica. Homeopathic; 1903.
7. Kent JT. Repertory of the homoeopathic materia medica. B. Jain Publishers; 1992.
8. Barthel H. Synthetic repertory. B. Jain Publishers; 1974.
9. Lessell cb. A textbook of dental homoeopathy: for dental surgeons, homoeopathists and general medical practitioners. Random house; 2011 aug 31.
10. Buck H. The Outlines of Regional Symptomatology in Homoeopathy. 1997
11. .B tanuja, reddy siva rami. Role of homoeopathic medicines in dentistry. International journal of homoeopathic sciences. 2017;1(1): 08-10.
12.  Sivaraman P. Tooth Troubles Cured with Homoeopathy. India: B Jain Publishers; 2001..
13. Dutta AC. Homoeopathic Treatment Systematized & Simplified. B. Jain Publishers; 2001 Jun 30.