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Are Dentists Contributing to Prescription Opioid Abuse?

January 10, 2017

Filed under: Pain control,Pain Medications — Tags: , — Dr Gillis @ 7:00 am

Are Dentists Contributing to Prescription Opioid Abuse?  The answer is probably!

Are Dentists Contributing to Prescription Opioid Abuse?  Our dental office hopes to do what we can to prevent contributing to narcotic abuse.  The questions we will be asking are:

  1. Do our patients need a narcotic prescription after their dental treatment?
  2. How many tablets is appropriate?

Have you ever had dental surgery?  Have you ever been prescribed opioids for pain?  Were you one of the many who left several tablets unused and not disposed of correctly?  That is Prescription Opioid Abuse.

Prescription Opioids - sometimes needed, sometimes not!

Prescription Opioids – sometimes needed, sometimes not!

The rate of overdose deaths due to prescription narcotics or  Prescription Opioids has more than tripled in the past 20 years!  And, it is a fact that using narcotic pain pills when they are not needed can contribute to addiction.

A recent study noted that 100 million prescription opioids go unused every single year following tooth extractions.  Another study conducted by the University of Pennsylvania Schools of Medicine and Dental Medicine found that more than half of opioids prescribed were left unused by the patients.  There is an opioid epidemic currently.  Evidence shows that people who abuse prescription opioids often use leftover pills that were prescribed for friends or family members.  Your dentist should not be contributing to this epidemic!

Pain following a typical dental procedure such as an uncomplicated extraction is effectively managed with over-the-counter (OTC) medications.   Most dental pain is due to inflammation,and most NSAIDS like ibuprofen have strong anti-inflammatory effects.

What we want! Smiling, comfortable patients!

What we want! Smiling, comfortable patients!

Many articles confirm that  providing opioids like oxycodone or hydrocodone

  • Does not decrease inflammation any more than ibuprofen
  • Does not prevent opioid abuse, and
  • May lead directly to opioid overdoses, exposing you to opioid abuse, leading to possible dependence and opioid overdose death!

Although Hydrocodone/Tylenol combinations are the most wisely prescribed analgesic in the United States, there is no published data indicating that they result in pain relief any better than common NSAIDS like Ibuprofen or Naprosyn.  My recommendation (ooh the self promoting blog!) would be to read our blog on pain management after dentistry (http://blog.juliegillisdds.com/). If you do have leftover prescription narcotics or opioids – dispose of them correctly!

Yours for better dental health,

Julie Gillis DDS, PC

Restoring Smiles/Restoring Health

Managing Pain After Dentistry

January 3, 2017

Filed under: Pain control,Pain Medications — Tags: , , — Dr Gillis @ 7:00 am

It is very important to our office that we effectively manage pain during and after dentistry!  Managing pain after dentistry is typically done with Prescription opioids but may be more effectively managed with other safer medicines.

Pain following a typical dental procedure such as an uncomplicated extraction is effectively managed with over-the-counter (OTC) medications.   Manage inflammation and you will be managing pain after dentistry! Most dental pain is due to inflammation, so this is important to prevent.  Most NSAIDS (Non-steroidal anti inflammatory drugs)  like ibuprofen have strong anti-inflammatory effects.

Trauma to front tooth led to the surrounding inflammation, gum recession and pain.

Managing pain after dentistry or dental trauma is important!  Trauma to the front tooth led to the surrounding inflammation, gum recession and pain.

What is inflammation? Inflammed skin or gums may appear red, swollen and painful. The tissue may also feel warm, and may have lost function.  Inflammation is part of the body’s response to harmful stimuli, such as bacteris,  damaged cells from surgery, or trauma.  This is your body’s response at a cellular level that includes your immune cells and your blood vessels.  Evidently, tissue becomes inflammed to help remove the cause of the cell injury, and begin the process of repair.  The downside of this is pain or discomfort.

Managing pain after dentistry leads to happier patients!

Managing pain after dentistry and of course, during dental treatment leads to happy, comfortable, satisfied patients.

Here are a couple other suggestions your dentist may do to help with managing pain after dentistry or dental trauma and be as comfortable as possible following dental treatment:  Note: goal is minimize inflammation, to delay the onset of pain, minimize the pain intensity and prevent acute pain.

  1. Give NSAID before pain occurs or while you are still numb!
  2. It is helpful to take prescription dose of NSAID (400 mg to 600 mg Ibuprofen) prior to your procedure.  Try taking two OTC Ibuprofen about 30 minutes before your appointment.
  3. Your dentist can add additional long-acting anesthetic (0.5% bupivacaine with epinephrine) at the start of a short procedure or near the end of a longer procedure.
  4. Take NSAIDs in the appropriate amount by the clock for 48 – 72 hours after treatment.
  5. Add OTC Tylenol as part of the medications taken after surgery if not taking Ultracet which contains acetaminophen. Tylenol 600/650 mg by the clock either with the Ibuprofen listed above or alternated every 3 hours to maintain blood levels of both medications.
  6.  Use ice if swelling present, 20 minutes on/20 minutes off for 24 hours
  7. Prescribing Tramadol (Ultracet) for 3 days may be very beneficial without the abuse potential of other narcotics. Ultracet combined acetaminophen with tramadol which is an orally effective opioid drug with much less abuse potential than an oxycodone or hydrocodone combination.  (2 tablets of 325-mg acetaminophen plus 37.5 mg tramadol (Ultracet) every 4 – 6 hours)
  8. For mild to moderate pain you may just need ibuprofen 400 mg to 600 mg every 4-6 hours by the clock for the first 48 – 72 hours until pain subsides.

Together we can help decrease opioid abuse!

Yours for better dental health,

Julie Gillis DDS, PC

Restoring Smiles/Restoring Health

 

Prescription Narcotics or Opioids Are Prescribed Too Often!

December 29, 2016

Filed under: Pain control,Pain Medications — Tags: , , — Dr Gillis @ 9:45 pm

Narcotics or Opioids Are Prescribed Too Frequently!

Prescription Narcotics or Opioids have contributed to too many deaths recently!

The over prescribing of narcotic pain relievers had become a big problem.  An article in the June 2016 COMPENDIUM had these things to say about pain prescriptions and pain management.  A 2015 study showed that it takes less tablets of fast acting Ibuprofen 400mg to obtain 50% pain relief following all types of surgery than Ibuprofen 400mg with ocycodone 5 mg (a Prescription Narcotics or Opioids)!  Ketoprofen 24 and Diclofenac potassium 100 required even less tablets.  The number of tablets of Codeine needed to provide 50% pain relief over 4 to 6 hours was more than four times as many as ibuprofen 400 mg  (2 tablets vs 9 tablets)!

What we want! Smiling, comfortable patients!

What we want! Smiling, comfortable patients!  If this can be achieved with minimal prescription opioids or narcotics that is even better.

 

Prescription Narcotics or Opioids are sometimes needed

What can happen! Prescription Narcotics or Opioids – sometimes needed, sometimes not!

Prescription narcotics or opioids may not even be needed after uncomplicated dental treatment or surgery.  The June COMPENDIUM article noted that 400 mg Ibuprofen (that’s two OTC tabs of Advil) is superior to 650 mg aspirin, or 1000 mg Tylenol (acetaminophen), or even combinations of aspirin and Tylenol plus 60 mg of codeine or 30 mg of dihydrocodeine.  Someone taking more than 400 mg ibuprofen may modestly prolong the duration of pain relief but will likely not result in increased pain relief.  Other NSAIDs such as naproxen sodium may achieve comparable pain relief without the narcotic complications.

Our office would like to do what we can to prevent prescription narcotic abuse.  We also want to make sure you are comfortable after dental treatment!

It is interesting to look at how pain medications work.  I think your mind contributes a lot to this.  So, if you think something like a prescription narcotics or opioid will work it has a much better chance of working!  My dad, a Family Medicine MD for 40+ years, often told us the story of being in terrible pain one night and going to the bathroom cupboard for a pain pill.  (He had some narcotics at home in case this was needed).  He accidentally took a tablet of penicillin which was in a similar bottle and his pain went away.  Of course, the penicillin had nothing to do with the relief of his pain.  His mind, however, had everything to do with his pain relief!

You are welcome to call our office for more information. (970) 242-3635

We are very concerned about your comfort during and after dental treatment!

Yours for better dental health,

Julie Gillis DDS, PC

Restoring Smiles/Restoring Health

 

1190 Bookcliff Ave. Suite 201, Grand Junction, CO 81501 USA
Julie M Gillis DDS Grand Junction, CO cosmetic, general, & restorative dentist. (970) 242-3635 (970) 242-8479 jgillis@juliegillisdds.com