'I write almost no prescriptions for narcotics. And my patients are comfortable.'

As a dentist and longtime practitioner in the Philadelphia area, I am sad to hear about the addiction problems that the medical profession has inadvertently caused, or at least abetted. Much of it has been needless.

I have done a lot of oral surgery and root canal treatment over the decades. Yet I write almost no prescriptions for narcotics, and haven't in years. And my patients are comfortable.

In dental school, we were taught to write prescriptions for Tylenol III, a mild narcotic. Over time, Vicodin became available, and became the drug of choice for pain, due to increased effectiveness. The company even sent me free samples so I could get my patients started until they could pick up their prescriptions. Still, as a conscientious doctor, I only gave enough medication for a couple of days, which was all that was warranted. 


Related story: Dentists try a new approach for pain: fewer opioids 


This is what I was taught, and what I did – until I learned there's a difference between pain relief and pain control. Now, I practice pain control.

It is easier to control pain than to try to relieve it after it occurs. Barring any medical conditions that would suggest otherwise, I have patients take a "loading dose" of 800 mg of ibuprofen (e.g. Advil or Motrin) one hour before a procedure, and every 6 to 8 hours afterward, by the clock, for 48 hours in order to remain comfortable. The "loading dose" makes the medication available to combat the chemicals that are created by our bodies as a result of injury. This is enough to keep many patients comfortable. If more is needed, I have them add 1000 mg. of acetaminophen (Tylenol) in between the doses of ibuprofen.

Since these two medications combat pain in different ways, they are, research shows, just as or even more effective than opioid prescriptions when used for pain, and without the narcotic side effects. Since most pain is gone after 48 hours, I tell patients to discontinue this by-the-clock routine, and just take ibuprofen as necessary, typically 400 mg. every 4 to 6 hours. (The above is an example of how I work with selected patient. It is not intended as specific instructions for you, the reader; always check with your doctor about what medications will be safe and effective for you.)

I learned this routine almost 20 years ago, before the current epidemic of addiction and overdose deaths was on anyone’s radar screen. Even then, studies showed that this practice – Advil in advance and for 48 hours, then supplemented with Tylenol if needed – was equal to or better than opioids.

A footnote: I used the same routine myself for an outpatient surgical procedure that was supposed to be very painful. The surgeon, following his own routine, gave me narcotics. I never needed them.

Routine prescribing of opioid pain relievers is what we were taught in school for many years, and medical professionals become creatures of habit. Patients, too, frequently think that they "need" a narcotic script after certain procedures. Put the two of them together and prescriptions for opioids becomes the norm.

But the norm may not be what is best.

Steven J. Schwartz, DDS, practiced dentistry in the Philadelphia region for many years. He is now an executive coach and works on issues of dental training, practice, and product development and marketing as CEO of the consulting company he founded, Progressive Dental Ventures LLC.


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