Rethinking Pain Management Is OverdueThe opioid epidemic is one of the most pressing health crises of our time, with more lives lost to opioid-related overdoses than to cancer, HIV, or heart disease. It’s a sobering reality and as dental professionals we must ask ourselves - are we part of the problem? More importantly, how can we be part of the solution? The time to take an in depth look at pain management and rethink our reliance on opioids is now. Dentists in the United States write a surprising number of opioid prescriptions, far exceeding dentists in England. In 2016, dentists in the United Stated “prescribed approximately 11.4 million opioid prescriptions, accounting for 22.3% of all dental prescriptions. In contrast, English dentists issued about 28,082 opioid prescriptions, representing only 0.6% of their total dental prescriptions. This indicates that U.S. dentists prescribed opioids at a rate 37 times higher than their English counterparts” (Suda et al., 2019). Studies show that young patients who receive opioid prescriptions for dental procedures - especially wisdom tooth extractions – are at a higher risk of developing opioid use disorders (Schroeder et al., 2019). Even more concerning, approximately 6.9% of individuals who have not previously used opioids... patients continue using them long after their dental pain subsides (Reynolds & Schwarz, 2019). The truth is - opioids are not always the best choice for dental pain. Research proves that NSAIDs (like ibuprofen) alone or in combination with acetaminophen provide equal or better pain relief with far fewer risks (Moore et al., 2018). The message is clear: the way we prescribe needs to change and we need to embrace alternative pain management methods. Alternative Treatments for Oral Pain ManagementNSAIDs are the gold standard for dental pain relief. They work by targeting inflammation at the source rather than affecting the brain like opioids do. Studies show that ibuprofen (400–600 mg) with acetaminophen (500 mg) is more effective than opioid-containing medications (Dionne et al., 2016). Beyond medications, there are other pain management strategies gaining traction. Local Anesthesia and nerve blocks can provide excellent relief, while cryotherapy, low-level laser therapy, and transcutaneous electrical nerve stimulation (TENS) offer promising alternatives. With that being said, what are those? Let’s become informed together:
Legislation has helped tackle the crisis with many states now limiting opioid prescriptions for acute pain to just seven days. Some states also require dentists to complete opioid education when renewing their licenses. One of the most impactful changes has been expanding access to naloxone (Narcan), a life-saving medication that reverses opioid overdoses. Many states allow pharmacists to distribute Narcan without a prescription, and some even permit dental professionals to prescribe or administer it in emergencies (National Institute on Drug Abuse, 2021). Massachusetts General Hospital and other major health organizations even provide free Narcan to their employees. Having worked there myself and with my brother, a pediatric ICU Nurse, currently working there - we have seen this first hand. While these measures are making a real difference, there is still more work to do. How Can Dental Hygienists Make A Difference?Depending on the state, dental hygienists may have the ability to administer emergency medications like Narcan. As frontline healthcare providers, hygienists are in a unique position to educate patients about opioid risks and alternative pain relief options. While time with our patients is limited during appointments, considering the addition of an opioid screening tool to dental visits could help identify at-risk individuals and get them the help they need before it may be too late. Strict Opioid Policy: U.S. Military Making A DifferenceMany service members joke that the only thing they’re prescribed, regardless of the injury, is ibuprofen. While it may seem humorous, the rule is a necessary precaution given the high risk of addiction among veterans. Studies show that veterans are twice as likely to die from accidental opioid overdoses compared to the general population, and nearly 15% of military service members report misusing prescription drugs, most commonly opioids (National Institute on Drug Abuse, 2019). Stammering statistics led the military to take a strict stance against opioid prescriptions, limiting their use to extreme cases. Given the intense physical and emotional trauma soldiers endure, limiting opioid prescriptions is a critical step in preventing substance abuse and long-term dependency. What Does The Surgeon Say?The 2015 Surgeon General’s Report, Facing Addiction in America, reframes addiction as a medical condition rather than a moral failing; An impactful statement and essential to comprehend as medical providers. One key takeaway? Adolescents who experiment with alcohol or marijuana are significantly more likely to misuse opioids later in life (Levy et al., 2018); This makes early intervention and education critical. Harvard, Tufts, and other leading institutions now prioritize non-opioid pain management, ensuring the next generation of dental professionals is equipped to combat this crisis in their practices. The opioid crisis demands action and the dental profession has an opportunity to lead by example. By prioritizing non-opioid pain management, supporting legislative policy changes, and educating patients on safer alternatives, we can make a tangible impact. Change starts with us and the time to act is now.  If you need assistance, 988 Lifeline is there - for free: 988lifeline.org/ References Dionne, R. A., Gordon, S. M., & Moore, P. A. (2016). Prescribing opioid analgesics for acute dental pain: Time to change clinical practices in response to evidence and misperceptions. Journal of the American Dental Association, 147(7), 537–544. Fjeld, M. G., Heyeraas, K. J., & Krogstad, B. S. (2020). Low-level laser therapy in the treatment of temporomandibular disorders. Pain Research and Management, 2020, 1–9. Levy, S., Breen, L., Lunstead, J., & Weitzman, E. R. (2018). Facing addiction: A laudable, but incomplete effort. American Journal of Public Health, 108(5), 598–599. Moore, P. A., Hersh, E. V., & Gordon, S. M. (2018). Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. Journal of the American Dental Association, 149(4), 256–265. National Institute on Drug Abuse. (2021). Naloxone drug policy. https://www.drugabuse.gov/naloxone National Institute on Drug Abuse. (2019). Substance use and military life. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life Sharma, S., Gupta, D., & Patil, P. (2019). Role of TENS in managing chronic dental pain. Journal of Pain Research, 12, 1221–1232. Suda, K. J., Durkin, M. J., Calip, G. S., Gellad, W. F., Kim, H., Lockhart, P. B., Rowan, S., Thornhill, M. H., & Hershow, R. C. (2019). Comparison of opioid prescribing by dentists in the United States and England. JAMA Network Open, 2(5), e194303. https://doi.org/10.1001/jamanetworkopen.2019.4303 Tseng, Y. C., Alessi, A., & Donoff, B. (2015). The role of cryotherapy in postoperative pain control. Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, 120(3), 326–330.
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