A friend recently had a partial knee replacement. I visited during her at-home recovery and she expressed shock at how few pain pills were prescribed. As a dentist, I understand her side, but then that of her doctor’s as well.
As a dentist in Shelby Township, I know how sensitive teeth and gums can be. I chose the dental profession because I’d spent many visits in my youth having dental work. Upon opening my first dental office in Macomb County, I was determined that patient comfort would always be a priority – a longstanding reputation we’re quite proud of.
This leads me to address the relief of dental-related pain. In recent political publicity, our nation’s opioid epidemic has gained front-&-center attention. The problem affects whole families and has impacted crime statistics in entire communities, entire states, and our entire nation.
The realities of opioid use and abuse aren’t pretty. In 2018, the Agency for Healthcare Research & Quality cited more than 615 opioid-related emergency room visits for every 100,000 people in the U.S. with even higher numbers for low-income and minority groups.
Healthcare workers in the American healthcare system are very much aware of the complexities surrounding the need for pain relief combined with its overuse. While doctors don’t want to deny legitimate patients the medications needed to ease patients through pain until treatment can resolve it, neither do we want to contribute to the nation’s growing dependency or add to an already existing habit.
For the most part, I believe the dental profession has been very careful along these lines. Typically, strong pain meds are only prescribed for patients with dental needs when pain levels are most extreme (for procedures such as root canals or extractions).
Generally, dentists have been conservative yet practical in prescribing harsh “pain killers.” According to the American Journal of Preventive Medicine:
“In 2019, U.S. dentists provided 10.9 million opioid prescriptions, representing 7.6% of the opioid prescriptions dispensed that year.”
In March of 2018, the American Dental Association (ADA) announced a new policy to bolster the role of the dental professional in combating the opioid epidemic, publishing a policy that “supports mandates on opioid prescribing and continuing education.”
Included in this is the statement:
“The ADA supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the Centers for Disease Control and Prevention evidence-based guidelines.”
Past guidelines have encouraged dentists to consider “non-steroidal anti-inflammatory analgesics as the first-line therapy for acute pain management” rather than rely on opioids. This refers to NSAIDs, an acronym for non-steroidal anti-inflammatory drugs. In this category are pain relievers that include aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Aleve, Naprosyn), and ketoprofen (Orudis).
In many cases, these can be effective in relieving pain by reducing inflammation in the bone, dental pulp, and gum tissues. However, before taking these meds, it’s important to know what to expect and how they work.
NSAIDs have been shown to manage acute pain as effectively as opioids for reducing pain intensity. There are a wide variety over-the-counter (OTC), which means they need no prescription. Yet, because they can be purchased right off the shelf, many people assume these medications are safe.
Yet, many OTC pain meds have side effects and interact with other medicines, dietary supplements, and alcohol consumption. Because pain medications contain the same ingredients found in many prescription pain relievers, adults may be taking a risky dose when combining medications.
Because of an increased potential for stomach inflammation, peptic ulcers, and intestinal bleeding, the risk is higher for regular NSAID users or those who take high doses. This is especially true for older adults. Taking NSAIDs in high doses or for an extended time can increase the risk especially for this age group.
According to a report from NBC News, Americans take too many OTC pain relief meds. A study conducted by a Boston University School of Health researcher showed that nearly one in five users of popular headache remedies like Advil or Aleve admitted to exceeding the recommended daily maximum dose during a one-week period.
The risks associated with overconsumption can go even further. Overuse of NSAIDs has been found to inhibit an enzyme responsible that protects the gastrointestinal lining, blood flow to the kidneys, and blood clotting. There is also the potential for higher risks of cardiovascular issues, including heart attack and stroke.
Rather than using an NSAID, dental pain may also be managed by using Acetaminophen (such as Excedrin and Tylenol). Acetaminophen is an internal analgesic available OTC for the relief of minor aches and pains and helping to reduce fever.
Acetaminophen should also be used only in the recommended dosage. Because it can also be found in medicines that treat migraines, headaches, muscle aches, and menstrual cramps, it is best to stick to its use as advised.
Let’s work together to protect our population from the horrible effects of opioid addiction. Prior to treatment, we will discuss the potential for discomfort or pain afterward and standard treatment options to help ease you through recovery. We can also discuss using Oral or I.V. Sedation (“twilight sleep”) during your visit. These are safely administered and often eliminate memory of the procedure afterwards.
If you are experiencing sore, tender gums that bleed easily when brushing or a deep ache like a toothache, do not delay in seeking dental care. When something is wrong in the mouth, there are very few instances that will go away on their own. Most problems worsen over time, leading to higher levels of discomfort and more-involved treatment to resolve the problem.
As a Shelby Township dental office, we want to help your oral health interact positively with your overall health. If you have questions or wish to discuss your dental goals and concerns, call us at 586-739-2155. You are welcome to begin with a free consultation to get to know us, or schedule an exam and cleaning.
To learn more about our dental office, take a brief office tour at: DrBarbatTour
And, to get to know me before our time together, view: MeetDrBarbat
Additional Sources:
https://www.deltadentalwa.com/blog/entry/2019/09/dental-pain-management
https://hcup-us.ahrq.gov/reports/statbriefs/sb280-Dental-ED-Visits-2018.pdf
