Dentist’s today are generally in too much of a hurry; quick to diagnose a problem and quick to treat (operate). When there is not enough time in the dentist’s schedule to treat the problem, often, pain pills / medications and antibiotics are prescribed. Nowhere in this scenario was an effort made to truly learn anything about the patient.
When inadequate amounts of time are taken to really get to know our patients, inappropriate treatment can be done, despite good intentions. Our patients’ primary concerns, their goals and desired outcomes, feelings about dental care, and previous dental experiences are critical in properly considering a plan for treatment.
Do we still need pain pills in Dentistry?
Today, prescription pain medications are often “given out” with little regard to the patient’s history of substance abuse or considering the significant potential of creating chemical dependency.
Trust is a must.
For those new in recovery, it can be an uncomfortable experience discussing your recent strides in sobriety. An unnecessary pain medication can be just the thing to trigger a relapse.
It is critical that patients feel comfortable trusting their dentist to non-judgmentally understand them, care for them, and help them. Trust does not come easy, but can be earned. A dentist who will listen without judgment can create a doctor-patient relationship through empathy, openness and honesty.
Taking a gentle and conservative approach can do wonders in preventing pain during and after a dental procedure. By taking our time to carefully deliver local anesthetic (novacaine), consciously working gently, and protecting all the areas we are not operating on (lips, cheeks, etc.), we can minimize and even eliminate the typical discomforts and pains associated with dental procedures.
Alternative to Opiates
Do dentists really need to prescribe these medications? I promote the increasingly popular notion that combinations of NSAID’s (non-steroidal anti-inflammatory drugs) are not only an effective alternative, but also a preferred choice.
There are several advantages to utilizing these medications, not only from an abuse potential perspective, but from proven clinical effectiveness. Combinations of acetaminophen and ibuprofen have been demonstrated to be equally as effective in managing acute dental pain, and in recent studies to be more effective (literary references here).
Why risk chemical dependency?
We know that there is a genetic predisposition for a percentage of our population to chemical dependency. Some argue that those who become chemically dependent are predisposed to this condition, while others argue that abusing substances creates the dependency. Often with good intention, someone provided someone addicted to opiate pain medication their first prescription.
Some facts about pain pills in dentistry:
- Over 25 million tablets of opiate pain medication (Vicodin, Oxycontin) were sold in 2012.
- 15% of all the opiate pain medication prescribed are prescribed by dentists.
- 50% of those who report using recreational opiates or pain pills received the pills from family or friends.
Helping keep these medications out our patients’ hands may not only help our patients, but also help their families and friends. These medications carry a significant risk for creating a chemical dependency. Without the absolute need for these medications to be used in the management of dental pain, I advocate for prescribing these medications sparingly. Also, having deliberate and meaningful early conversations with our patients may help make those in recovery feel comfortable and thus help prevent the potential for relapse.