Diagnosis of the cause of a patient’s dental pain and then treatment for that condition is the way in which dentists eliminate dental pain. Prior to diagnosis, during diagnosis, and post-treatment, there are situations where a patient is suffering, and I do have pain control advice.
With opioid addiction on everyone’s minds, I thought I would run through my answers to pain control questions I get from patients.
“My tooth hurts. Can I have prescribed medication for pain?”
A dentist is not going to routinely prescribe opioids for acute dental pain. The reason is that the combination of ibuprofen and acetaminophen is more effective and has fewer side effects than narcotics. If a patient has a medical condition that precludes taking ibuprofen or acetaminophen, ketorolac tromethamine is a good alternative, and we will discuss this.
“What is the combination of ibuprofen and acetaminophen that makes it so effective and safe?”
The typical adult can take 1 tablet of Ibuprofen (600 mg) and 2 tablets of acetaminophen (500 mg) every 6 to 8 hours — for just as long as necessary to control pain. But medical history, age, and body weight will be a consideration. My approach to care is always individualized for the patient. We will have a conversation.
“Will this procedure hurt? Will I need prescribed medication for pain?”
Again, rarely is an opioid prescribed, even after tooth extraction. This is because the combination of ibuprofen and acetaminophen is more effective and has fewer side effects than narcotics. Local anesthetic applied at the site of treatment numbs nerves, so treatment itself is not the issue. Patients have had experiences with post-treatment swelling of the gum tissue and/or tenderness in their jaw muscles, but discomfort associated with this is easily alleviated with ibuprofen or acetaminophen. You might not even need to try the combination. Patients may feel gum and jaw muscle tenderness for one to three days. Cold compresses applied to the outside of the cheek near gum swelling also reduces associated discomfort.
If an opioid is indicated for pain control, I always check the state’s prescription monitoring program prior to writing the prescription. This way, I know that I am not providing narcotic medications to any patients who are abusing them. Opioid prescriptions for acute pain should be no more than 20 low-dose, short-acting opioids. This will cover three days of medication only because physical dependence can develop in as few as five days.
~ Jamie J. Alexander, D.D.S., Your Boynton Beach Dentist