By Mary Otto

In recent years, officials at the federal level have made a point of including dentists in their work to stem the flow of opioids. A leader in the effort, Vivek Murthy, M.D., who served as U.S. surgeon general under President Barack Obama, urged health care professionals – including dentists – to consider alternatives to opioids when helping patients to manage pain.

“We want people to reach for non-opioids whenever possible,” Murthy stressed in launching 2016 his campaign to combat the opioid crisis.

In 2017, President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis did not overlook the nation’s dentists when calling upon health care providers to join a broad effort to limit the flow of addictive painkillers to the American public.

Research has highlighted the importance of including dentists in such campaigns.

As the authors of a 2016 research letter published in the Journal of the American Medical Association (JAMA) concluded, dentists had regularly prescribed opioids to treat post-extraction pain “despite evidence that a combination of nonsteroidal medications and acetaminophen may provide more effective analgesia for post-extraction pain.”

Finding alternatives

Since then, mounting evidence has supported the non-opioid approach.

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain than opioids, a major 2018 systematic review concluded.

The paper, which examined the results of more than 460 published studies, looked at the safety and efficacy of dozens of options for relieving acute pain in dentistry.

“The best available data suggests that the use of nonsteroidal medications, with or without acetaminophen, offers the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events,” one of the study’s authors, Anita Aminoshariae, an associate professor at the Case Western Reserve School of Dental Medicine, explained to the school’s news service.

For adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was more effective than any of the opioid-containing medications that were studied, the research found.

Across the country, state health agencies have been working to get out the word to oral health providers.

In the spring of 2019, Delaware health officials stepped up efforts to raise awareness about the addictive nature of opioid medications prescribed following common dental procedures including wisdom tooth extractions. In a campaign stressing the message that “all pain is not the same” they teamed up with the state dental society to distribute informational pain management tool kits to every dental office in the state.

“By no means would we ever try to tell the prescriber how to treat pain, because certainly, that is always going to be a decision best managed by the provider and the patient on their own,” Nick Conte, the state’s dental director, told reporter Nick Ciolino of Delaware Public Media.

“What we’re really trying to do is make sure everyone has the best and most current information available.”

Professional groups’ efforts

Dental professional groups have also gotten involved.

In a 2017 white paper, the American Association of Oral and Maxillofacial Surgeons acknowledged the epidemic nature of opioid addiction in America and emphasized the need for provider judgment in prescribing painkillers for dental pain.

The American Dental Association has supported continuing education on opioid prescribing practices for dentists and a seven-day limit on opioid prescriptions for the treatment of acute pain.

Member dentists have been urged to consult databases maintained by state-run prescription drug monitoring programs, which could help them identify “doctor-shopping patients” whose prescription histories might reveal drug-seeking behavior.

The American Dental Education Association has called upon the nation’s dental educators to raise awareness among their students.

Covering the issue

For telling a story about the interface between dental pain management and opioid dependency, Philadelphia radio journalist Elana Gordon’s piece, “Dentists Work to Ease Patients’ Pain with Fewer Opioids,” offers a great example.

The report, which aired on National Public Radio’s Weekend Edition Sunday in 2017, includes the memorable account of a dental-patient-turned-addict who recalled that an important moment in his struggle with drugs came when he was 17. His wisdom teeth had been removed and his dentist prescribed a narcotic for the pain.

Those pain pills, Gordon reported, “eventually derailed his life.”