Talk to your patients about pain medicine and weigh the risks and benefits before prescribing.
It’s common to prescribe an immediate-release opioid analgesic in anticipation of moderate to severe pain. Many dentists believe that opioids are best for treating pain and more effective than over-the-counter (OTC) medications. But recent studies show that the majority of patients experience no meaningful benefit from opioids, and the risks may include physical dependence and overdose. In fact, OTC medications have been proven effective in successfully reducing pain and should be the first line of therapy.
Dentists can play a key role in reducing opioid use.
As dental providers, we need to better educate ourselves and our patients regarding the etiology of pain, pain management options, and the dangers of opioid use. We play a vital role in ensuring the well-being of Delawareans in the future by prescribing the appropriate medication. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) should be the first line of treatment for most post-procedural pain.
The right dose and time for the right patient and procedure.
A glucocorticoid followed by NSAIDs in combination with acetaminophen should be considered the first-line analgesic regimen for most patients. Prescribe the “perfect formula”:
- A 4mg dose of dexamethasone (a glucocorticoid), either before or during the procedure
- Follow it up with a combination of ibuprofen (600mg) and acetaminophen (1000mg) every six hours for 24 hours
If all other options have been exhausted and a patient’s pain is so severe that an opioid is necessary:
- Thoroughly review the patient’s health history by checking the Delaware Prescription Monitoring Program (PMP)
- Prescribe only enough medication for the first 24 to 48 hours post-procedure
Opioid combination analgesics (also called “shotgun” preparations) have a maximum recommended therapeutic dose (MRTD). No more than 12 units of medication should ever be prescribed at one time. If a patient requests pain medication past 48 hours post-procedure, they should be re-evaluated by a dental practitioner. Prolonged pain can be a sign of poor healing, infection, or addiction.
What to tell your patients: Not all pain is the same and neither are pain medicines.
Opioids are not needed to manage most types of pain after a dental procedure. Opioid pain medications can be addictive. OTC medications, in many cases, are just as effective in managing pain as opioids. Be sure to talk with your patients about their concerns and expectations, so they are assured that they will receive the pain management that is right for them.