Do Patients Need Opioids Following Dental Procedures?

Do Patients Need Opioids Following Dental Procedures? by Lynn R. Webster @LynnRWebsterMD

According to Fox News, “The American Dental Association recently reported dentistry is responsible for prescribing 12 percent of all instant-release opioids.” The article quotes Dr. Mojgam Fajiram, DDS, of Sutton Advanced Cosmetic Dentistry, who claims the dental industry gives out opioid prescriptions much too quickly “just to treat chronic pain.”

Treating Pain from Dental Procedures

In any case, Dr. Fajiram doesn’t seem to think that “just” treating pain is a good enough reason to provide a patient with an opioid prescription. “In fact, taking a combination of acetaminophen and ibuprofen will decrease the inflammation without the adverse effects of vomiting, headache and nausea — and abuse,” according to him.

If that doesn’t work, Dr. Fajiram offers simply “icing the affected area for 20 minutes on and 20 minutes off to decrease inflammation, using a mouthguard or injecting Botox to control jaw joint pain, and trying acupuncture.”

I agree that most people with minor dental procedures can do just as well with a strong anti inflammatory. However, some patients may benefit from a few days of stronger pills.

Dr. Fajiram says that some dentists use opioids so they can say to their patients, “Don’t call me, just come see me in seven days and everything will be better.” Painkillers, Dr. Fajiram implies, are used for the convenience of dentists who, in many cases, are actually treating patients’ fear of dentists rather than actual pain associated with dental procedures.

Why Are Painkillers Used for Dental Procedures?

Dr. Fajiram is correct in saying that most surgical dental pain gets better in 7 days. That is the normal course of acute pain from minor trauma. I also agree that opioids are often prescribed to address the fear of pain by some patients.

However, some individuals may experience considerable pain during those 7 days, and there should be some recognition of a potential need for prescription painkillers.

This brings back a painful memory for me.

Memory of Dental Pain

I grew up on a farm, and my childhood was a happy one. I was surrounded by family members who loved and nurtured me. Still, unexpected circumstances inevitably arose.

When I was a 10-year-old child, I had a tooth abscess. I was taken to my country dentist. I was frightened. I did not know what to expect, but I was in miserable pain. My country dentist took his hot pointed knife and lanced my abscess without numbing the area. I screamed. He said he couldn’t numb it, but he assured me before proceeding that the procedure would be quick. It was, but it was unbelievably painful.

Okay, we can live through acute pain. However, it does create a memory that seeds other pain experiences. In my case, that experience stayed with me long after the pain itself was gone. Of course, we’re not talking only about dentistry.

When I was practicing anesthesia, I noticed the fear in children who had had several previous operations. Children exposed to multiple operations know what they will experience with subsequent operations. This leads to anxiety and triggers a painful experience for most children even before they are exposed to a painful stimulus. That’s bad enough. But, for some, it can lead to PTSD which is an even more serious condition that can last a lifetime. I clearly remember my experience of childhood pain, and it happened almost 60 years ago.

Deciding How to Treat Pain

According to the U.S. Department of Veterans Affairs, approximately 15% to 35% of patients with chronic pain also have PTSD. Chronic pain is always preceded by acute pain.

As the U.S. Department of Veterans Affairs points out, “Every person is different and perceives and experiences pain in different ways. There is often very little consistency when different doctors try to measure a patient’s pain. Sometimes the care provider may not believe the patient, or might minimize the amount of pain. All of these things can be frustrating for the person in pain. Additionally, this kind of experience often makes patients feel helplessness and hopeless, which in turn increases tension and pain and makes the person more upset. Conversation between the doctor and patient is important, including sharing information about treatment options.”

It’s bad enough to experience pain or its untended consequences. However, it’s worse to neglect to ask patients how much pain they are experiencing, and then to unilaterally decide which situations warrant a prescription drug. Even patients themselves sometimes have difficulty in communicating their pain. In those cases, it’s up to their medical team to help, and not to ignore their patients’ experience of pain.

Above all, the decision of how to treat pain should never be solely placed in the hands of a third party such as a policymaker or insurance company. Pain treatment should be the decision of the dentist or doctor that’s made with in conjunction with the patient.

Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

The Painful Truth @lynnrwebstermd Lynn R. Webster

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Copyright 2017, Lynn Webster, MD


  1. Kenneth Mckenna on February 28, 2017 at 5:28 am

    Spot on Dr. L.W. I can report that right now things have been better at the VA. They’ve slowed the opiate tapers realizing yanking people off meds sets them up for long term problems. I fear the dentist. Now a days it’s all about anti inflammatories. You are correct everyone’s perception of pain is different. Where someone else might react to a procedure one way, someone else may have a totally different experience. I’ve heard many dentist & even some doctors no longer have answering services because patients used to call after hours requesting pain meds. This seems like a dangerous presidence. Thank you for all you do.

  2. Anne Fuqua on February 28, 2017 at 7:26 pm

    Thank you for being the voice of reason! All dental procedures and all patients are NOT created equally. I have had more root canals and crowns (genetic defect that causes soft enamel) than I want to count, but there was only ONE root canal that I ever needed anything beyond acetaminophen and ibuprofen. It wasn’t great but I never understood what the horror stories were about until I had the rude awakening of having a root canal on abscessed tooth. It was TERRIBLE, but with a additional doses of the opioidI take on a daily basis, it was MUCH better. I can’t imagine going through that – even if it DID go away after a few days. NO ONE should feel that if they don’t have to feel it.

    I can’t imagine how this crackdown will affect patients who really fear the dentist and need work done. I can see people winding up with serious infections, just because they are afraid of the procedure and post-op pain.

  3. Rachael Perrin on March 16, 2017 at 3:25 am

    I’ve had my share of dental trauma because Novocaine simply doesn’t work for me. My last procedure was for a crown, and they shot dental bleach into my nasal cavity. It’s something that rarely happens, and just as the dentist was explaining it to the assistant…it happened. He was too busy chatting.

    Now 2 years later, and on Subuxone because BuTrans isn’t covered by my insurance…my very healthy teeth have cracked and that crown post snapped in half. Subuxone is the direction they are pushing chronic pain patients, but it numbs the mouth so there is zero pain…but incredibly fast destruction of teeth, confirmed by my new dentist. More and more common, but not a warning on any labeling. I have to wean completely for oral surgery and I’m grateful to be free from this medication because of the unexpected side effects. Dental work is incredibly expensive and I never imagined this could happen to me.

    I fear what’s next and will not work with a dentist who is not compassionate in prescribing. They’ve taken away traditional opioid medication from so many who are being moved to sublingual Buprenorphine, if anything at all. But my physician was surprised when my dentist called her. In what world is this a remotely fair trade? Give up your smile for pain relief? The entire system is stacked against us and becoming more and more destructive. I viewed it as a safer alternative and insurance won’t cover $30k worth of dental work. If anyone believes it’s from lack of hygiene, read reports of complete loss of all front teeth, occurring within 6 months of initial treatment for some. This must be addressed as part of a holistic treatment!

  4. Nitrous on April 5, 2017 at 10:40 am

    Acute pain management is interesting. Percocet works well for acute pain….but so does tramadol. The expectations around efficacy need to be different but the end result should be tolerable relief. I don’t know where the balance is but I do know where the risk lies. I’ve got a current C6 radiculitis. It will take time to resolve. Is tramadol “enough”? Again, I don’t know. It’s not as “good as Percocet” but it certainly is more than adequate. We have to be so careful on managing expectations. Both from the patients perspective and the prescriber perspective. This is a real challenge. Fortunately, I’ve not reached the point of “I don’t care about the risk” in managing my pain but I know many who seem to believe they have reached that point. The results are often disasterous. Is this a problem? Yes! Can it be managed? Yes.

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