Every health professional has their own view and opinion in terms of ‘what’ is necessary to control a patient’s pain. In addition, we realize that patients differ from one another in terms of their pain tolerance.
There are different factors which influence the type of pain medication I’ll prescribe, if any at all…These are:
1) How well do I know the patient?
Familiarity is a primary factor. When seeing a patient for the first time, I am less likely to prescribe a strong narcotic. Fact is, some people have a history of drug abuse and will go from one practitioner to the next to get narcotics. Although this is rare, it does happen.
2) What do I feel is really needed to control the pain?
In most cases, I prescribe an anti-inflammatory, such as Ibuprofen (Motrin). A lot of the discomfort that people feel is from inflammation that results due to the actual procedure. So it is best managed with an anti-inflammatory…this is tied in with number 3 below.
The pain level that we target for most dental procedures is in the mild to moderate category. The Anti-Inflammatory group is best suited to treat this. The Narcotic group is more geared towards severe pain. We will discuss this further in the next blog.
3) What procedure was done on the patient?
For something like a Root Canal, the most suitable medication is an anti-inflammatory. When we clean the inside of the root system with these specialized files, we usually cause some inflammation; hence, the best way to treat this is with an anti-inflammatory.
The same goes for an extraction. Usually an anti-inflammatory will suffice, but at times I will give Tylenol with codeine. The ‘level’ of codeine will depend on how difficult the extraction is and the perceived pain tolerance of the patient…and again, my familiarity with the patient.
For a procedure like a cleaning or a filling, it’s unusual that I will prescribe pain medication. These procedures don’t normally result in patient discomfort, but if they do, an over the counter medication is adequate to deal with it.
4) Stoic nature of the patient
Every now and then, a patient comes along and says “no, I don’t want freezing”. I think to myself ‘how am I going to work on them?’
You see, as a dentist doing dental work on someone, I don’t want to have to worry that the patient is feeling what I’m doing, or else I’ll feel anxious and that I’m hurting them.
However, with ‘stoic’ people, I don’t usually encounter any problems if they’re not frozen. They don’t squirm about in the chair or complain about anything.
Don’t get me wrong, this ‘no freezing principle’ basically applies to a procedure like a dental filling and not usually to a more involved procedure like a root canal or an extraction. But, even with these procedures, when I do offer them a pain medication, in many instances, they tell me they don’t need it.
On a personal note
I have been practicing dentistry for over 24 years. In all of this time, I have only prescribed what I feel is a strong narcotic on one occasion. This was for a patient that had been in my practice for at least 10 years and who I knew quite well. As it turned out, he never even ended up taking any of it and if my memory is correct, I don’t even think he filled the prescription.
In the next entry, we’ll look at the difference between an anti-inflammatory and a narcotic medication.
