Part I- The physiology and biochemistry of pain perception
Weeks 1-2
Three lectures dealing with the fundamentals of pain perception and propagation in the oral cavity with special emphasis on the factors responsible for generation of electrical potentials in nerve fibers, These lectures would expand upon the fundamentals of electrical and chemical potential generation from the fundamental neurophysiology material given in the fall and winter quarters of the first year and would focus on signal propagation along the anatomically different nerve fiber groups associated with the oral cavity in general, pulp and periodontium. In addition, lectures on synaptic control of the transmission and perception of pain in relation to the oral cavity would be discussed. At this point I would just focus on pain on not other proprioreceptive or other oral sensations, and leave those topics to the second in the series of these courses on the anatomy, neurophysiology and muscular physiology of occlusion and TMJ function.
Part II- Classification and Fundamentals of Diagnosis of Oral-Facial Pain
Weeks 3-5
A series of three to four lectures dealing with the principal sources of dental/oral-facial pain including.
a. pain of strictly neurological origin
b. pain of muscular origin
c. pain of vascular origin
d. pain from inflammation and necrosis
For each of these topics we would expand upon the basic principles given in the first two weeks of this course with emphasis both the physiology and the anatomical pathways of the propagation and perception of these pain sources. These discussion of the anatomical pathways of different types of oral-facial pain would serve as a bridge to the next series of topics on local anesthesia. This section would end with small group clinical correlation exercises including fundamentals of differential diagnosis of oral-facial pain based upon history and description of clinical, laboratory and other findings.
Part III- Fundamentals of Local Anesthesia
Weeks 6-8
An integrated series of 3-4 lectures on the pharmacology of local anesthesia and anatomical basis of local anesthesia techniques, followed by student practice on each other in some of the basic topical, infiltration, and nerve block techniques. This section would end with clinical -basic science correlation small group discussions dealing problems on local and systemic influences on local anesthesia. Such small group discussion topics would center on a series of clinical problems such as systemic implications of inadvertent intravenous injection , effects of local inflammation etc. and would tie together both the clinical and basic science principles learned up to this point.
Part IV- Introduction to Systemic Control of Dental/ Oral -Facial Pain
Weeks 9-10
Two lectures on the pharmacological basis of the control of dental pain with special emphasis on the actions and uses of NSAIDS. (Steroid drugs and opiate analgesics would be given in the second or third year course dealing with more advanced topics in pain control). This would be followed by a final lecture on the basic psychological considerations in the perception and control of dental/oral-facial pain. The final small group discussion would focus on clincal problems involving the influence of medical conditions and psychological factors on local anesthesia and on non-prescription analgesia, and would serve as a bridge to the next pain course in this series.
