The More You Know

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

There are two issues I would like to discuss today. The first being about pain relieving efforts following dental surgery and the second about lowering the risk of virus transmission within the dental office.

We have been inundated with debate about the pros and cons of “following science and listening to our scientists”.  I have always been an advocate for evidence-based dentistry and during this pandemic I have watched and participated in more webinars than I care to think about. But staying up with the literature and being a lifelong student have always been a challenge within this profession.  The opiate epidemic within our country has caused me to re-examine how I prescribe medication for dental surgery pain.  Not that I don’t use opiates (a narcotic analgesic) anymore, but the literature has given me alternatives to consider as I evaluate each particular situation. A centrally acting narcotic has addictive liability that has to be weighed against the amount of pain relief that you are achieving with its use. And can you, with appropriate patient compliance, receive the same amount of pain relief with other options?

The American Dental Association (ADA) recommends considering non-steroidal anti-inflammatory drugs (NSAIDS) as first-line therapy for the management of acute pain. The following studies specifically show that naproxen sodium mono-therapy and ibuprofen/acetaminophen combination therapy may be alternatives in treating dental pain.

-In two single dose studies, patients who took naproxen sodium (Aleve) 440 mg. reported significantly reduced pain compared to those taking acetaminophen plus codeine (Tylenol #3) 660 mg./60 mg. from the three hour mark onward.

-In a single dose, 12 hour study, 1 and 2 pills of the single pill combination of ibuprofen/acetaminophen 200 mg./500 mg. were statistically and significantly more efficacious than placebo and acetaminophen/codeine 500 mg./15 mg.  Also, the 2 pills offered significantly superior pain relief to ibuprofen/codeine 200 mg./12.8 mg.

The side effects to opiate use besides addiction liability are also that its use is not recommended for the young pediatric population. Dry mouth and constipation are also annoying side effects to this medication.  As always, having a conversation with your doctor/dentist about his/her plan for dealing with post-operative pain is always recommended.

The second topic I wanted to touch on today is our use of a hydrogen peroxide pre-rinse before dental treatment in our office. Hydrogen peroxide has been shown to be very effective in killing the coronavirus in laboratory studies. Lowering the viral load within the oral cavity should be a clinical aim in undergoing treatment. We ask our patients to swish for one minute prior to being seen. As we all know, the taste and oxygen release and bubbly that takes place on swishing with this mouth rinse is particularly annoying. But due to the fact that asymptomatic carriers are probably a part of our daily schedule, we ask all of our patients be compliant with this request. This pandemic has been highly stressful for all of us but treating you safely and effectively has been and will always be a central goal at Spring Lake Dental Group.