To safely use narcotic-pain medications following oral surgery procedures there are several things you must know. Recently, the NBC report, ‘The Deadly Triangle: Dentists, Drugs, and Dependence,’ talks about the risks of drug dependence among patients when prescribed opioids by their dentists following certain dental procedures.
Effective pain management is an important part of patients’ recovery following dental surgical procedures like teeth extractions, bone grafting, or dental implants. Two main categories of analgesics for pain management are narcotic (opioid) medications such as Vicodin or Percocet and over-the-counter non-narcotic pain medications such as Tylenol or Ibuprofen. Narcotic pain medications can be highly habit forming. Therefore, dentists and patients should always discuss the pain management strategy and understand the benefits and risks of such medications.
Guidelines on how to prescribe and use narcotic pain medications responsibly to reap its benefits while minimizing its risks:
- Prescribe medications appropriate to the expected pain from the planned procedure: some dental procedures such as gum grafting, simple extractions, and extraction of upper teeth, generally induce less post-operative pain. Hence, over-the-counter anti-inflammatory drugs such as Tylenol or Ibuprofen may be sufficient. A less potent narcotic pain medication like Tylenol #3 may be considered as necessary.
- Prescribe enough narcotic pain medication for only 3-4 days: The pain associated with most dental procedures begin to diminish after 3-4 days. Hence, dentists should only prescribe enough narcotic medications to last for that period. This means 12 to 16 tablets of Vicodin or Percocet with no refills. After this period, most patients can switch to Tylenol or Ibuprofen for management of their mild to moderate post-operative pain. A very limited amount of additional narcotic pain medications may be prescribed for patients who may experience continued pain not resolved by over-the-counter non-narcotic medications.
- Patients with history of drug addition should inform their dentists of their prior history and inquire about alternative analgesics to narcotics which can cause relapse in their rehabilitation.
- Parental supervision for patients less than 18 is of paramount importance. Parents should monitor the narcotic pain medication usage and dispense them only as directed. Under no condition, should underage patients have complete possession of their narcotic pain pills and use them without supervision by parents or an older responsible person.
- Dentists should question patients who request high number of pills or call frequently for refills. This may be a red-flag for an individual who is a drug abuser. Dentists should inform patients that such drugs are highly habit forming and advise them on alternative pain management strategies.
- Dentists should inform patients or parents of the serious nature of opioid pain medications and openly discuss its risks. Patients need to ask questions and understand such medications and use them cautiously with full understanding of its benefits as well as harmful side effects.
As dentists, we want our patients to be comfortable and pain-free during their post-operative recovery. However, we must prescribe such medications with absolute diligence and responsibility. With good communication, conscientiousness prescribing methods, and responsible usage, patients can enjoy the benefits of narcotic pain medications. Following these recommendations will minimize its potential habit-forming risks and prevent dangerous side effects from over-dosage.
Dr. H. Ryan Kazemi is a board-certified oral and maxillofacial surgeon in Bethesda, MD.