Opioids in Dentistry: What You Should Know
Have you ever been afraid of going to the dentist? Whether your fear is based on prior bad experiences or the potential for pain, you’re not alone.
However, many dental patients express a different fear regarding dental pain: potential addiction to prescribed pain treatments. Opioids are a type of narcotic pain medication often prescribed after major dental procedures. Opioids work by reducing pain signals to the brain. They are very effective in treating pain; however, they also carry a risk of addiction.
Opioid abuse and overdose has been an increasing epidemic across all ages, genders, and classes in the United States. A stunning national statistic reveals that although the U.S. represents 5 percent of the world’s population, it consumes 80 percent of the global opioid supply. According to the NC Department of Health and Human Services (NCDHHS), from 1999 to 2016, more than 12,000 North Carolinians died from opioid-related overdose.
Fear of opioids or opioid addiction creates a tricky situation for patients who might be wondering, “How is my dentist going to make sure I am not experiencing pain or suffering, while also avoiding addiction to the pain medications prescribed after dental procedures?’ At Carolinas Dental Choice we make sure to work with you to safely manage your pain.
What are opioids?
Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others, according to the National Institute on Drug Abuse. At first, opioids produce feelings of pleasure or euphoria. After repeated and prolonged use, the brain develops a tolerance towards its effects and begins to crave the pleasure-inducing effects, despite becoming less susceptible to the actual pain relief of the drugs.
How addiction to opioids starts
Opioids are very effective in treating pain, especially when someone is in high pain and needs immediate relief. Often, and unfortunately, addiction may be an unforeseen result of a legitimate need for pain treatment. Opioids like morphine, codeine, oxycodone, and hydrocodone are highly addictive and lead to physical dependencies.
Opioids are prescribed for short-term pain management and aid in treating severe pain. Opioids used over a longer period become less effective, which may drive the urge to take higher doses in order to achieve the same effect as when the medication was first started.
What does addiction to opiates look like?
• Using drugs past the prescription or initial pain treatment
• Becoming tolerant and needing the drug more often
• Having withdrawals from the drug
• Strong desire or urge to use the drug
• Continuing use despite financial, legal, or social problems
Once the opioid is stopped, withdrawal symptoms can include muscle and bone pain, insomnia, diarrhea, vomiting, cold-flashes, and more. To lessen the chances of withdrawal take any prescription as directed and plan to taper down doses. Your doctor can help you create a plan to safely reduce your medication use while managing your pain.
Opiates at the Dentist: What’s the problem?
Dentists are the second highest prescribers of opioids in the U.S. Over the past few years however, opioid prescriptions from dentists have been in decline. On average, dentists prescribe three days worth of opioids to their patients, aiming to only administer the lowest-potency opioids for short periods of time for conditions associated with severe pain.
Procedures and conditions that call for opioid prescriptions can range depending on the patient’s pain tolerance and preference, but most commonly include:
• Wisdom teeth surgery
• Tooth/Molar extraction
• Dental infections
• Surgical trauma
The American Dental Association announced new policies to combat the opioid epidemic in March 2018, which include continued education in prescribing opioids and other controlled substances, and statutory limitations on opioid dosage and duration of no more than 7 days for acute pain.
Manage pain responsibly
There is a no one-size-fits-all for treatment, so talking to your dentist to determine what course of action is best for you is a great place to start. At Carolinas Dental Choice we encourage you to update your dentist on your health history, share what medications you might be taking, and disclose if you or someone in your close family are in recovery or have struggled with addiction in the past.
We want to have a conversation with you to answer these questions:
• What is the goal of this prescription?
• At what time and when should I take these?
• How long should I take these drugs?
• Are there risks from this medication?
• What do I do with any extra medication?
Dentists and patients alike need to be on the same page about the perception of pain for these dental procedures, as well as what realistic expectations are for their pain treatment. The goal of pain management is exactly that — management not magic. Often patients may expect to feel absolutely no pain after procedure and anxiety about pain can actually contribute to feeling it. Experiencing a little bit of pain is okay. It will help you keep track of whether something actually hurts and needs treatment or you are continuing to take a medication out of habit. Only treat your pain to the point that it is manageable and does not interfere with your quality of life.
How to treat dental pain without opioids
Opioids are not usually dentists’ first choice to send home with patients. The alternatives to opiates include familiar medications. Over-the-counter pills can be just as effective for controlling pain, and safer, as they are nonsteroidal anti-inflammatory drugs (NSAID).
In a recent study by The Journal of the American Dental Association, the most effective pain relief with the fewest side effects is 400 milligrams of ibuprofen with 1,000 milligrams of acetaminophen. They also found that this combination is more effective than any other opioid or opioid-containing drugs. Most patients can find pain relief with a combination of Tylenol and ibuprofen, or even aspirin, which are easily accessible and inexpensive.
Patients should keep in mind that unlike opiates, the over-the-counter drug combinations may not work as instantly to relieve pain—but, when used correctly and consistently, these NSAIDs will relieve pain as effectively. At Carolina’s Dental Choice we recommend other pain relief measures such as hot or cold compresses, topical numbing gel, and comforting things such as taking a shower or bath, meditating, or distracting oneself with a favorite activity.
Most people associate major dental procedures with some lingering pain, sensitivity, and discomfort. But if you’re experiencing excessive pain post-dental procedure, don’t hesitate to contact us. Your dentist may recommend an additional evaluation, or develop an alternative pain management plan suited for you.
Struggling with an addiction? Get help.
Various treatment options and resources are available to help people with addiction. Your primary care doctor, dentist, or any other health professional can help assess the situation and recommend treatment options.
Other useful resources centralized in NC include:
The Alcohol/Drug Council of North Carolina
Carolina Healthcare System #ThisisSober Campaign
North Carolina Council of Community Programs – Treatment Services Guide