Pain management in Canine dental cases

Canine oral discomfort is a commonly underdiagnosed condition and it can manifest in different ways. Luckily there are ways we can identify and manage this discomfort. During this lecture we will touch upon the different oral disease processes which are associated with oral discomfort as well as take a detailed look at how we can manage this pain. We will look at what considerations we need to consider in these cases as well as look at a case example at the end.
A lot of our cases are very stoic and tend to show very minimal signs of pain, continuing to eat and play as normal, which can make diagnosis very difficult. In these cases, we rely on more subtle signs such as they may eat on one side more than the other or they are preferring a soft diet over a hard diet. Behavioural changes such as aggression and anxiety have been seen in these cases as well as the dogs appearing to have reduced activity levels similar to an older dog. Some cases can present with more obvious signs such as rubbing at their faces and anorexia. With most of these cases, a lot of the changes are noticed following treatment, where a lot of clients realise that there was something wrong prior to the treatment and they note that their dogs appear to have regained their youth. This shows how detrimental oral discomfort can be.
There are multiple conditions of the oral cavity which can cause oral discomfort which we will discuss in detail. These include inflammatory conditions such as periodontal disease and canine chronic ulcerative stomatitis, traumatic injuries, malocclusions as well as abscessation and oral tumours. We will also cover tooth resorption and whether it is considered painful in dogs.
In veterinary dentistry we have access to a range of different forms of analgesia which work on different areas of the pain pathway. These include opioids, non-steroidal anti-inflammatory drugs, α2 agonists, acetaminophen (paracetamol), GABA analogues and NMDA antagonists. We use this in combinations and at different doses depending on each patient whether it be pre-, post- or during the procedure. By using combinations or medications, we can ensure that the patient remains pain free and we can lower the amount of anaesthetic agents used. In some cases, we cannot use high doses of systemic analgesia and therefore, we also use local anaesthetic nerve blocks. We will discuss all of these analgesics in detail.
Finally, we will look at a real case and our approach to managing its pain pre-operatively, during and post-operatively. This case involved resection of a large maxillary mass and had some complications which we will discuss. We will also focus a lot on the post-operative nursing care for this case. This case is a great example of the use of multimodal analgesia for oral pain management.
The aim of this lecture is to help you identify key signs of oral pain and how to manage them effectively using a multimodal analgesia approach. By effectively managing each patients pain, the anaesthetic and recovery process will be improved.