Dentist Jamie J. Alexander of Boynton Beach, FL, has a long history of NOT prescribing opioids to dental patients except in a limited way in rare circumstances. “For years I’ve known from published research and clinical experience that dental pain is better managed with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS),” say Dr. Alexander, “And, with the opioid epidemic on everyone’s mind, I’m glad to report that a recently published review of five in-depth studies confirms this.”
The review was undertaken by researchers in Case Western Reserve University Dental School’s Department of Endodontics and featured in The Journal of the American Dental Association. These researchers reported that ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDS) alone or in combination with acetaminophen not only reduce acute dental pain better than opioids but have a long-lasting effect.
“We don’t want patients to be in pain,” says Dr. Jamie Alexander, “but opioids should not be the first option. I recommend ibuprofen alone or in combination with “acetaminophen for optimizing oral pain relief and minimizing adverse effects.”
“What we know is that prescribing narcotics should be a last resort,” said Anita Aminoshariae, an associate professor at Case Western and one of the study’s authors.
The goal of the systematic review was to summarize data, using five in-depth studies of the effectiveness of oral pain medications, across all age populations. The medications evaluated in these studies were limited to medication (and medication combinations) marketed in the United States. The research found that, for adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was superior to any opioid-containing medications studied.
The study also found that, in both children and adults, opioids or drug combinations that included opioids accounted for the most adverse side effects, including drowsiness, respiratory depression, nausea, vomiting, and constipation.
“I like to have a conversation with my patients about managing discomfort and pain, based on their individual health history, pain tolerance, and the circumstances creating discomfort. Dental related pain may arise from such swelling of gingiva after extraction of a tooth or from inflammation in a tooth’s pulp,” says Dr. Alexander. “At Boynton Beach Dentistry, I diagnose the source of the pain and fully inform patients about what to expect before, during and after treatment to eliminate the source. Understanding the inflammatory process and how long there will be discomfort, helps patients cope with pain and manage it better. Usually, four to five days after a surgical procedure, discomfort in gum tissue is so slight that even ibuprofen isn’t needed. And, as soon as a tooth has been numbed for a root canal or another restorative treatment, pain inside the tooth ends and does not return once the source of pain has been eliminated. Ibuprofen easily eases post-treatment discomfort in the soft tissues of the mouth where injections were received, or a little bruising may have occurred. Patients typically manage this type of discomfort well, even without NSAIDS.”
Caring about you as a whole person, deserving of personalized attention, ensures your experience is optimal. “Our patients know we are only a phone call away,” says Dr. Alexander, “and willing to talk.
We schedule enough time with each patient to make sure you are comfortable and your concerns are addressed. I’m happy to say that we have an excellent track record with nonnarcotic pain management. We also have experience helping dental patients who are in recovery from opioid addiction, so if you or a close relation is in need of a dentist who understands your special concerns, we are here to help.”