Pain Management in Dentistry: Safe and Effective Alternatives to Opioids
Dr. Jose Lança
Assistant Professor
Clinical Sciences - Pharmacology - Faculty of Dentistry
Department of Pharmacology & Toxicology - Temerty Faculty of Medicine
In recent months, the opioid crisis has been somewhat overshadowed by the COVID-19 pandemic. But just because it has taken a back seat in the public eye does not mean that it has gone away.
“Opioid-naive patients who receive an opioid prescription from a dental clinician may be at risk of persistent opioid use and abuse. Adolescents exposed to opioids have a 33% higher risk of abusing them later in life.”
Dr. Lança presents the hard facts on opioid prescription and abuse in North America and reviews several evidence-based studies that support the use of Ibuprofen/Acetaminophen combinations as a valid alternative for pain management in the dental office.
We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.
Until next time!
CDA Oasis Team
Resource
Health Quality Ontario: Opioid Prescribing for Acute Pain – Care for People 15 years of Age and Older
With the opioid addiction epidemic ongoing, this is such an important topic. Thanks for covering it in OASIS.
Thank you so much for your informative presentation on alternates to opioid usage for pain control.
I am really hoping that CDA will consider a similar presentation on Benzodiazepine usage;, for insomnia, particularly in seniors 65 and older. Dr Gardner, and colleagues from Dalhousie University are working on research in this regard with seniors 65+ usage for insomnia New Brunswick only.. Usage Benzodiazepines Canadian average=10% New Brunswick=25%; this is interesting and they are looking at why? Including the possibility that some of these medications in New Brunswick are finding there way onto the street. It has been noted in the literature that Opioid pandemic is not the only one and Benzodiazepines are strongly noted as a problem as well. I hope CDA will allow you to address this!
That is a very important question. As I mentioned in detail in my email, the main difference among benzodiazepines relates primarily to their half-life, and onset and length of action (short- , intermediate- and long acting). Consequently, these relate to their therapeutic indications (e.g., pre-op sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant). All benzodiazepines share common adverse effects related mainly to frequency of use (i.e., motor and cognitive impairment, tolerance). In the present context, it is important to clearly state that they are also associated with dependence and addiction. Or, to use the current DSM-5 terminology, substance use disorder. The social impact of the COVID-19 pandemic has led to an increase in substance abuse. Benzodiazepine abuse is not immune to the negative. Finally, elderly patients are at a higher risk of presenting adverse effects from drugs, including benzodiazepines for a variety of reasons. Among those, a reduction in both kidney and liver functions – therefore limiting elimination and metabolism – and increasing the drug’s T1/2 life.
Can you please elaborate on centrally acting drugs in dentistry?
It is an important and extremely vast topic. The effects of so many drugs, as well as the adverse effects of so many others, are relevant to dentistry.
The shortest way to illustrate this, is to list some of these drug groups: 1. Opioids; 2. Benzodiazepines and other Anxiolytics; 3. Antidepressants.4. Anesthetics; 5. Antiparkinsonian drugs. 6. Endocrine drugs (e.g. anti-hypothyroid; antidiabetic); 6. Bronchodilators; 7. Antihypertensive drugs.
These are just a few examples. This list is very long. We need to be reminded that this relates not only to medications specifically used in dentistry, but also to the impact on dental practice that drugs with systemic effects have on oral health. See the patient as one.