Dentists have an uncanny, almost supernatural ability to understand their patients. I don’t know how many times I’ve been reclined on a dentist chair, having my teeth cleaned, when the dentist was carrying on a two-way conversation with me. He’d have his gloved fingers in my mouth and I’d be gagging out answers. Somehow, he’d always understand me. According to a recent article in the Pittsburgh Tribune-Review, dentists also apparently understand the role they play in the nation’s current opioid epidemic. “Most people who get their wisdom teeth removed go home with a prescription for Vicodin, a commonly prescribed painkiller that for many likely provided their first experience with an opioid,” the article said. For some, this is just the first step in a long, agonizing battle with painkiller addiction. Now, dentists are thinking twice about prescribing painkillers like Vicodin and exploring safer, opioid-free pain treatment options.
Are Dentists To Blame?
In the US, when it comes to managing the pain associated with dental work, part of the problem is that patients simply expect to get a Vicodin prescription. Many dentists feed that expectation and, as a result, open the door for addiction. Some research has “found the median number of hydrocodone pills dispensed to patients after extractions was 24. When oxycodone was prescribed, it was 16.” However, experts argue that’s too many pills given the pain and nature of the dental work.
Attitudes toward pain medication have completely changed over the last twenty years—and not for the better. Last year, a California Dental Association (CDA) lecturer observed that health care providers like dentists prescribe painkillers at an unprecedented rate. In the past, when a patient reported pain, the “prescriber would usually give just the bare minimum to deal with that pain. But the pendulum has swung completely the other way over the past 10 to 20 years,” one expert said. He called attitudes about pain management “more aggressive” rather than decades before, where health care professionals were far more “stingy” with their prescriptions. It’s an attitude shift that, in the long run, is costing lives.
Is Aspirin The New Vicodin?
Instead of prescribing “quick-fix” opioids like OxyContin and Vicodin, dentists are trying alternative methods of pain management. New research has found that “combinations of over-the-counter pain medication and anti-inflammatory agents are more effective at managing dental pain than opioids in many patients, and they are less dangerous,” the Tribune-Review article noted. Anti-inflammatories like ibuprofen, naproxen and aspirin aren’t simply effective in combating the pain of dental work—they’re actually better at it than Vicodin, research results have shown.
Unfortunately, not everyone is on board with this approach. Dr. Paul Moore, of the University of Pittsburgh School of Dental Medicine, knows that there’s a lot of work to do to convince patients and physicians alike that there are options beyond Vicodin: “It is difficult to change traditional thinking and initiate alternative drug therapies that may involve acquiring new knowledge in pharmacology and therapeutics. As health care providers, our attitude is often to stay with what we know and trust. Although this attitude is not surprising, it is not always in the patient’s best interest.” Skeptics need look no further than the stats around opioid addiction and overdoses. According to the CDC, nearly 500,000 Americans died from an opioid overdose between 2000 and 2014. That’s 80 Americans who die every single day. While it seems unlikely anyone would question non-opioid pain treatment, old habits and expectations don’t vanish overnight.
Open (Expectations) Wide
Dentists currently prescribe “12 percent of all of the immediate-release opioid prescription drugs,” which is slightly below the number prescribed by family doctors. The dental community’s role in driving opioid addiction is a significant one, but one it’s clearly working to fix. Identifying red flags and risk factors is the first step in helping to curb the epidemic. For starters, as a CDA legal counsel pointed out, “there are enough bad actors [who]target dentists to collect and aggregate small amounts of controlled substances.” Knowing drug-seeking behavior when they see it will go a long way toward helping the cause. Dentists are also reducing their prescription sizes by half. In Pennsylvania, they’ve gone “from the 20- to 30-pill bottles of 10 years ago to 12 to 16 pills.” That way, leftover opioid pills won’t find their way into the hands of drug-abusing family members or others.
Dentists are also paying closer attention to the age of their patients, since most painkillers are prescribed for wisdom teeth removal—a procedure that “most patients undergo between ages 16 and 24…when they are more prone to addiction than in later life.” Other steps include requiring follow-up appointments rather than simply refilling prescriptions and setting clear expectations with patients upfront about their pain management options. They’re also taking other measures, such as building public awareness around “safe pill use, storage and disposal.”
Regardless, patients remain surprised whenever their dentists recommend an OTC medication after large procedures. “A lot of times patients expect some type of a prescription drug, and when the dentist does not give it to them, in their mind, they feel they need it,” one dental expert told the Tribune-Review. And when they don’t get what they want, patients turn to social media to complain, which reduces the number of referrals: “These dentists are facing kind of a no-win situation.” In light of the US drug crisis, healthcare professionals have a responsibility to work toward reaching a happy medium with their patients. There’s certainly a need for opioid painkillers in treatment, but it’s on physicians to better identify that need. One way or the other, it’s clearly going to take time. Just as there’s a long road to recovery for people addicted to opioids, there’s an equally long road ahead for changing patients’ attitudes and expectations.