According to Fox News, “The American Dental Association recently reported dentistry is responsible for prescribing 12 percent of all instant-release opioids.” The article quotes Dr. Mojgam Fajiram, DDS, of Sutton Advanced Cosmetic Dentistry, who claims the dental industry gives out opioid prescriptions much too quickly “just to treat chronic pain.”
Treating Pain from Dental Procedures
In any case, Dr. Fajiram doesn’t seem to think that “just” treating pain is a good enough reason to provide a patient with an opioid prescription. “In fact, taking a combination of acetaminophen and ibuprofen will decrease the inflammation without the adverse effects of vomiting, headache and nausea — and abuse,” according to him.
If that doesn’t work, Dr. Fajiram offers simply “icing the affected area for 20 minutes on and 20 minutes off to decrease inflammation, using a mouthguard or injecting Botox to control jaw joint pain, and trying acupuncture.”
I agree that most people with minor dental procedures can do just as well with a strong anti inflammatory. However, some patients may benefit from a few days of stronger pills.
Dr. Fajiram says that some dentists use opioids so they can say to their patients, “Don’t call me, just come see me in seven days and everything will be better.” Painkillers, Dr. Fajiram implies, are used for the convenience of dentists who, in many cases, are actually treating patients’ fear of dentists rather than actual pain associated with dental procedures.
Why Are Painkillers Used for Dental Procedures?
Dr. Fajiram is correct in saying that most surgical dental pain gets better in 7 days. That is the normal course of acute pain from minor trauma. I also agree that opioids are often prescribed to address the fear of pain by some patients.
However, some individuals may experience considerable pain during those 7 days, and there should be some recognition of a potential need for prescription painkillers.
This brings back a painful memory for me.
Memory of Dental Pain
I grew up on a farm, and my childhood was a happy one. I was surrounded by family members who loved and nurtured me. Still, unexpected circumstances inevitably arose.
When I was a 10-year-old child, I had a tooth abscess. I was taken to my country dentist. I was frightened. I did not know what to expect, but I was in miserable pain. My country dentist took his hot pointed knife and lanced my abscess without numbing the area. I screamed. He said he couldn’t numb it, but he assured me before proceeding that the procedure would be quick. It was, but it was unbelievably painful.
Okay, we can live through acute pain. However, it does create a memory that seeds other pain experiences. In my case, that experience stayed with me long after the pain itself was gone. Of course, we’re not talking only about dentistry.
When I was practicing anesthesia, I noticed the fear in children who had had several previous operations. Children exposed to multiple operations know what they will experience with subsequent operations. This leads to anxiety and triggers a painful experience for most children even before they are exposed to a painful stimulus. That’s bad enough. But, for some, it can lead to PTSD which is an even more serious condition that can last a lifetime. I clearly remember my experience of childhood pain, and it happened almost 60 years ago.
Deciding How to Treat Pain
According to the U.S. Department of Veterans Affairs, approximately 15% to 35% of patients with chronic pain also have PTSD. Chronic pain is always preceded by acute pain.
As the U.S. Department of Veterans Affairs points out, “Every person is different and perceives and experiences pain in different ways. There is often very little consistency when different doctors try to measure a patient’s pain. Sometimes the care provider may not believe the patient, or might minimize the amount of pain. All of these things can be frustrating for the person in pain. Additionally, this kind of experience often makes patients feel helplessness and hopeless, which in turn increases tension and pain and makes the person more upset. Conversation between the doctor and patient is important, including sharing information about treatment options.”
It’s bad enough to experience pain or its untended consequences. However, it’s worse to neglect to ask patients how much pain they are experiencing, and then to unilaterally decide which situations warrant a prescription drug. Even patients themselves sometimes have difficulty in communicating their pain. In those cases, it’s up to their medical team to help, and not to ignore their patients’ experience of pain.
Above all, the decision of how to treat pain should never be solely placed in the hands of a third party such as a policymaker or insurance company. Pain treatment should be the decision of the dentist or doctor that’s made with in conjunction with the patient.
Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.
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