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Download NowIncreasing attention has been given to the opioid epidemic in recent years, and for good reason. According to the Department of Health and Human Services, two million people had an opioid use disorder in 2018. On average, 130 Americans die every day from opioid overdose.
Health care providers must follow the pain management guidelines issued by the Centers for Disease Control to guard against the risk of addiction in patients. In the field of oral medicine, the question of when and what kind of pain medication should be prescribed is a constant topic of discussion.
At a recent talk at the Academy of Medicine, Dr. Elliot Hersh of the University of Pennsylvania presented research on pain management after oral surgery. Dr. Hersh shared insights from clinical trials of third molar (wisdom tooth) extractions, of which there are about five million cases annually. This is often the first time that young adults (aged 17-21) are exposed to opioids.
While it’s commonly assumed that opioids offer the greatest pain relief of any medication, the research has surprising findings about their ability to do so in an oral surgery context.
After an oral surgery, most (95%) of patients will experience moderate to severe pain between the first hour, up to three hours. Dr. Hersh explained that this pain comes from the inflammation of damaged cell membranes. Like any surgery, oral procedures can involve soft tissue and bone trauma. Because the pain is inflammation based, non-steroidal anti-inflammatory drugs (NSAIDs) have been recommended as a first-line treatment by the American Dental Association.
Dr. Hersh shared the following insights about pain management after oral surgery:
The research is definitive that NSAIDs work better than opioid analgesics for relieving pain from oral surgery. Opioids should only be added to this regimen in limited cases because 1) The relief they can provide for this type of pain is limited, and 2) They have addictive properties, which makes it harder to justify their use.
The advantages of NSAIDs for acute pain management include:
The limitations of NSAIDs include:
The dilemma faced by oral surgeons today is that patients are still numb from the local anesthetic at the time a medication prescription needs to be made. Pain tolerance varies from patient to patient. You can help your surgeon by sharing what your personal pain threshold is and what you might need in terms of relief during the first few days after the procedure.
There is no specific regimen that is guaranteed to produce a high level of relief after surgery, but various medication combinations can be considered.
Oral analgesic prescriptions are decided based on the procedure type and the anticipated pain level afterwards. Pain management can be achieved by targeting the source of pain (inflammation), for which NSAIDs are most appropriate.
In a systematic overview of 58,000 patients after wisdom tooth extraction, the combination of 400mg ibuprofen with 1,000mg acetaminophen was superior to any treatment that included an opioid.
Dentists must follow the CDC’s pain management guidelines as well as their state board’s recommendations when prescribing opioids.
While opioids do not target the root cause of pain after surgery, they do alter the nervous system’s response to painful stimuli. In other words, opioids can decrease the subjective experience of pain by blocking nerve receptors. It is precisely because of this powerful action on the nervous system that opioids are addictive in some people. Patients with chronic pain are at increased risk for developing an addiction if they take opioids for prolonged periods.
Your dentist will conduct a medical and dental history to determine current medications, the potential for interactions, and any history of substance abuse. Opioids can be used to treat moderate to severe pain when the patient understands their responsibility in preventing misuse as well as proper storage/disposal practices.
The dentists at Penn Dental Family Practice are leaders in evidence-based dentistry, both developing research and putting it into practice in their daily work with patients. If you suspect that you may need oral surgery soon, we encourage you to take advantage of the expertise of our skilled and knowledgeable specialists.
To make an appointment, please give us a call at 215-898-7337.
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