Dentists Seek New Pain Relief Options Beyond Opioids

Dentists Seek New Pain Relief Options Beyond Opioids

By Paul Gaita 02/28/17

Dentists are turning to over-the-counter medicines as pain relief alternatives for post-operative pain.  

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The rising number of overdose deaths from prescription opioids in the United States has impacted the health care industry in numerous ways, from hospital care and first responders to pharmaceutical manufacturers.

The front lines of the fight against opioid abuse is also affecting dentists and oral care physicians, who are responsible for 12% of prescriptions for fast-acting opioid pain relief like Vicodin—the third-highest number of prescriptions written by a medical professional group, after general practitioners and internal medicine doctors.

But as overdose and addiction numbers continue to escalate, dental boards and groups are seeking less risky alternatives to treat tooth extractions and other dental surgical procedures—and have found solutions that exist in most people's medicine cabinets.

Studies conducted by dentists and other medical groups have found that non-steroidal anti-inflammatory drugs (NSAIDs)—a class of drugs that includes aspirin, ibuprofen and naproxen—provide effective pain relief, when combined with opioids, for common procedures like wisdom tooth removal.

NSAIDs directly affect issues of inflammation, which dentists like Dr. Joel Funari say is a major contributing factor to post-operative pain. In 2014, Dr. Funari and a group of other medical professionals were asked by the Pennsylvania Department of Health to develop new methods of prescribing pain relief for dentists. 

The guidelines they created, which discussed a new way to combine opioid and NSAID medications for pain relief, have spurred additional studies at the national level, and new guidelines for opioid prescription for the American Dental Association—the first such update for the group in over a decade.

Despite these improvements, many established dentists, dental students and the general public still believe that opioids are the most effective means of pain relief for dental procedures.

Part of the reason for this long-standing belief is sympathy towards patients' fears and concerns over dental-related pain. "Dentists don't like to see patients in pain," said Funari. "We tend to be compassionate people, and I think we were falling into a trap we were creating ourselves."

Another element is the perception that NSAIDs are not as effective as prescription painkillers. "A lot of the lay public believes if they're available over the counter, they're weak and they don't work," said Dr. Elliot Hersh, a professor of pharmacology and oral surgery at the University of Pennsylvania School of Dental Medicine.

But NSAID advocates say that the reliance on opioids can create a disastrous scenario for both patients and medical professionals. Prescriptions for pain meds have often run to 30 or more pills after a procedure, which few patients complete; the excess pills or prescriptions can lead to both abuse or street sales.

Hersh noted that his classes often include observations about the wide-ranging impact of pain medication from a retired narcotics officer, who fully understands how the trail of excess prescriptions can impact both sides of the doctor-patient relationship. 

"I've been teaching my students that you have to be really, really careful with these drugs," he said. "That if you write too many of these prescriptions, for either good or bad intentions, either the state dental board and/or the DEA is going to come down on you."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites. 

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