Dentists Are Being Asked To Prescribe Over-The-Counter Pain Relievers Instead of Opiates

By Dorri Olds 08/12/16

Dentists are being called on to stop prescribing for the worst outcome and instead develop new prescribing strategies in an effort to curb opioid addiction.

Dentists Are Being Asked To Prescribe Over-The-Counter Pain Relievers Instead of Opiates

As the opioid crisis continues, so does the search for solutions. The dental field is rethinking the way to treat pain. The July issue of the Journal of the American Dental Association (JADA) discusses treating patients with over-the-counter pain relievers versus prescribing opioids. Many young patients in their teens to mid-20s are getting hooked on opioids after they’ve had their wisdom teeth taken out.

The JADA article states that many dentists prescribe medicine for "worst case scenario" pain in patients. The authors wonder if "by writing a prescription that may benefit 20% of patients who will experience severe discomfort, we unnecessarily provide 80% of patients with a prescription they may not need." The inability to predict who will experience severe discomfort is a major issue that dentists, general practitioners, and other doctors are still trying to figure out as they battle the raging opioid epidemic. 

The Fix spoke to one of the article’s authors, Elliot V. Hersh, DMD, MS, PhD, a pharmacology professor at the University of Pennsylvania's dental school.

“All of my students and oral surgeons who I’ve taught or done research with, know that non-steroidal anti-inflammatory drugs [NSAIDs] like ibuprofen [Advil] or naproxen sodium [Aleve] are the first line of drugs for post-surgical dental pain,” said Hersh.

“Besides being non-addicting, in double-blind placebo controlled studies they work as well—and in most cases, better than Vicodin and Percocet. So those [narcotics] should only be used when the NSAID is not working alone. Another trick that clinicians can use to avoid opioids for the most severe types of dental post-surgical pain is to combine the ibuprofen or naproxen with 500 mg of acetaminophen alone, which is essentially one Extra Strength Tylenol. This, most of the time, will eliminate the need for any opioids.”

The Fix also reached out to Brittany Ringersen, the president and CEO of Lighthouse Recovery Institute. As a teen, she became addicted to drugs prescribed by her dentist. After getting clean, she wanted to help others and created her treatment facility.

“At 16, I was given a 30-day supply of opiates for wisdom teeth extraction," she said. "The dentist never explained the risks to my parents, or me, and how my family should’ve handled dispensing the medications. We also weren’t told to dispose of them after I didn’t need to take them anymore. Two months later, I was using an opiate every single day for the next four years.”

Ringersen added, “I think dentists are aware of the opiate epidemic in this country but don’t believe they’re contributing to the problem. Dentists are prescribing the medications [because] it’s embedded in their daily routine.”

As of now, there are no laws that mandate how dentists should manage pain for their patients. They diagnose the level of pain and prescribe at their own discretion, but Ringersen says, “It’s much more than a physician turning a blind eye or being ignorant. I think it’s going to take a complete shift in their ideology before they’re capable of change. We’re essentially saying to intelligent physicians, ‘You are doing this all wrong!’ That is a big pill to swallow.”

Approximately 60% of the addicts that went for treatment at Lighthouse Recovery Institute had been given their first drug either by a dentist, physician, or got it from somebody’s medicine cabinet. Ringersen feels that most families aren’t aware of the problem and there isn’t enough education informing the public. “Parents and patients need to know they can say ‘no’ to a prescription, or request a non-narcotic instead of a habit-forming substance," said Ringersen.

"The blind trust people give their doctors is partly to blame. People need to ask questions. In a day and age when people spend less time speaking to doctors and are being rushed out of the room, the responsibility has to be shared between the patient and the doctor.”

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Dorri Olds is an award-winning writer whose work has appeared in many publications including The New York Times, Marie Claire, Woman’s Day and several book anthologies. Find Dorri on Twitter, Facebook, and LinkedIn.