SUBSTANCE USE DISORDER:
Addiction itself is a primary, chronic,
neurobiological disease. Its development
and manifestations are influenced by
genetic, psychosocial, and environmental
factors, but most importantly by age at
onset of use. Since addiction is a
developmental disease typically
beginning in childhood or adolescence,
we must be very careful in our prescribing
habits. It is particularly concerning for
us dentists, and especially oral and
maxillofacial surgeons, as a large
portion of our patient population is
between the ages of 12 and 18. It is
estimated that about 20 percent of
patients given opioids for pain
management may become addicted
to them, and in fact in a study at the
University of Pennsylvania showed that
over 6 percent of patients given opioids
will still be using them one year later
even though their original pain event is
far in the rear view mirror.
I WOULD SUGGEST
FIVE KEY CONCEPTS
to consider when approaching
patients with the idea that
narcotics will not be needed
for their recovery.
Other studies have shown that the more
pills a patient has been prescribed, the
more they will use.
So, what can we do to help mitigate
this crisis and so prevent us from further
contributing to it? We certainly have a
ground level role, in that we can control
our prescribing habits very effectively
by understanding what really works for
the vast majority of our patients. To a
large extent, at least initially when
weaning ourselves off of our old habits,
it is important to note that it takes 30
seconds to say yes and 30 minutes to
say no when prescribing. So, for too
many of us time-challenged professionals,
it becomes: What’s the easier and
quicker route to satisfying our patients
and our schedule? How do we go about
managing our patients when asking
them to accept the fact that they or
their child will not need a narcotic for
pain control?
Rapport: established
1. Patient
early and with respect for your
patient. Sit down and discuss
treatment thoroughly.
4.
Provide Reassurance: let the
patient know that they will get
significant relief with the
recommended dosages, and
Education: discussion
Available: patients should
2. Patient
5. Be be able
in a non-threatening consultation
to contact you after hours
area. Talk in lay terms.
Expectations:
3. Manage
remember the placebo effect
and the power of suggestion
that the NSAID/Acetaminophen
combination will work. Put the
suggested regimen on your
post op instruction sheet.
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If one looks at the mechanisms and
physiology of pain, it should be noted
that the pain we produce by our
procedures is primarily nociceptive,
that is, caused by activation of peripheral
nerve fibers by harmful and noxious
stimuli, which is precisely the type
of pain addressed by NSAIDs and
acetaminophen. Opioids act in the
CNS to affect the perception of pain,
and do not act therefore directly on the
origin of the pain stimulus. This is why
the CDC/ADA/PDA recommendations
have been developed and have been
shown in multiple studies of dental
pain to be most efficacious in terms
of relief for our patients.
JA NUA RY/F E B R UA RY 2019 | P EN N S YLVA N IA D EN TA L J O U R N A L
with problems and/or questions.
Rarely, a “rescue” prescription can
be called in i.e. (2-3 Tylenol #3 tab)