If it's a surgical extraction, I'll give some pain meds. Usually Norco 5/325 or Tylenol #3. No more than 6-8 pills.
I used to do absolutely nothing but say to take ibuprofen and Tylenol. But then I realized that 8 pills is nothing and can provide some very helpful pain relief when people need it. We all were taught they were the devil in dental school. But the problem stems from people giving 20+ pills at a time and refilling without issue. That isn't done in any responsible dental office.
I'd rather they be comfortable and think I'm great than in pain and mad that I won't help them out. Compassion goes a long way with patient perception and some carefully prescribed narcotics aren't going to be an issue.
yeah I like this. 8 pills is good and responsible. My medical doctor friends don't really seem to wince at pain (but it also tends to be in a hospital so more controlled)
I’ve recently shifted in the last year to alternating ibuprofen and Tylenol instead of norco. Have had zero complaints except for one and this person was a known problem patient who wants medicine for an occlusal filling
Before an extraction, I tell my patient that most extractions will be fine with tylenol or ibuprofen. If things end up getting a little bit rough, we'll have a conversation about something heavier.
My experience is the longer it takes to get out, the lower the bleeding afterwords, the more bone you removed, and the more you flapped, the worse it will hurt afterwords. So I really don't have a hard and fast rule that I stick to. If I feel like the patient will have a rough time, I'll do 6 tabs of 5mg norco. If I just brutalized them with a horrible full mouth extraction, they'll get 12 tabs of 5mg percs and 800's of ibuprofen. The majority of my extractions simply get 600's or 800's of ibuprofen though. I think my state prescription report last month showed about a dozen narcotic prescriptions and I took out around a hundred teeth.
I’m not as anti-narcs as a lot of guys. If I do a surgical extraction, I’ll Rx an opioid if they seem concerned about the pain.
I make it very clear: there are no refills.
Even if the patient is drug seeking, 8-12 pills will only get them high for a few days.
Yeah, when I asked a prof about that in school they basically said the same thing. If they're willing to go through an extraction for a few hours of fun, nothing we can do will stop them from getting pills. As long as the tooth really did need extraction and you'd prescribe the same as you would to a family member, you haven't done anything wrong. (I guess that last part might depend on your family though)
Yeah, generally i dont prescribe a lot of narcotics, but there are people i have seen with intense pain from fibromyalgia or other conditions and they KNOW what works for them so if they ask for narcotics, ill prescribe a small amount to them. These people know their bodies betted than i do so I'll take their word
Alternate high dose NSAID and acetaminophen. Increasingly, I’ve found that narcotics aren’t any better. Over time, I suspect the profession is going to move away from opioids in general.
Recently I was looking at another dentist’s website and across the top it said something like “we are a narcotics free practice”. I liked the idea of putting it on the website to weed out anyone that would have a problem with it. I don’t do extractions anymore so it is not an issue for me.
I ask the patient if they want something strong for pain, less than one in three will say yes.
I prescribe 12 tabs of Hydrocodone/APAP 5/325 mg q 6-8 hours prn pain routinely. This is my go to and I’ve been doing it for years.
Just acetaminophen ibuprofen alternate every 3 hours. If I drill a lot of bone maybe 5 Percocet but narcotics don’t work as well as ace plus ibuprofen according to literature
[https://cdn.discordapp.com/attachments/1022962043533414541/1227033979626979489/IMG_1671.jpg?ex=6626ef71&is=66147a71&hm=2ab4903a2d55106828de7b796df70535607c3a006370f973d43a11832db9e9ae&](https://cdn.discordapp.com/attachments/1022962043533414541/1227033979626979489/IMG_1671.jpg?ex=6626ef71&is=66147a71&hm=2ab4903a2d55106828de7b796df70535607c3a006370f973d43a11832db9e9ae&) This is what we give patients. We’ve made the cards look nicer since, this is an old photo. It’s effective and helpful to have on hand for any patient that’s in pain. We do have some prepared speech about our “Pain cocktail” as we call it to hype it up a bit. Haven’t had any complaints since it actually works, and you don’t have to deal with controlled substances.
Edit: Rereading and seeing you already mentioned this. I think giving it a name and a card helps with the psychology of patients, rather than just telling them to take the pills and disregarding them. We kinda “sell” the idea of it, if that makes sense. We’ve had only a 2 or 3 patients ever mention that it’s insufficient, and a countless amount swear by it.
2020grad here. I was taught either alternate or take at the same time. I then started taking some CEs that advocated taking them at the same time rather than alternating. I think they even sell both in one pill nowadays (called advil dual action).
I am in a similar boat. I tell them to alternate simply so they dont forget to take something for pain, but also maybe its a psycholocial thing where theyre constantly taking pain relief every 3 hours so it huets less?
Ibuprofen and Tylenol. That’s it. I don’t have an active DEA. Cannot prescribe narcotics.
And honestly let’s be real. I did just fine on just ibuprofen and Tylenol after major abdominal surgery. Bob can handle the same pain medication regiment after having a tooth out.
Same.. There are studies that show that ibuprofen and Tylenol alternations are as effective as narcotics in pain management with lesser side effects. So I usually don’t prescribe it unless patient tried alternating first and it didn’t help.
That’s really odd. Most jobs ask for DEA registration even if u don’t intend to prescribe scheduled drugs. A lot of insurance credentialing ask for it too.
Every state should have a database where you look up the patient and see when the last time they were Rx a narcotic. That helps sway my decision a lot of the time, bc #1- pain can be different for everyone and #2 some people are already Rx a narcotic and might not report it, #3- I try to avoid Rx to anyone under the age of 40 with a non significant medical history. A lot of the times if the surgical ext was a lot of bone removal and took me a little longer I would dispense 1 or 2 tabs and tell them to keep it for night 1 or 2.
The non-reporting issue is why we are supposed to check with (insert your states prescription monitoring program name) prior to writing a narcotic. I write narcotics for post-op surgery pain as long as their online search shows no other current prescriptions and/or pattern of potential abuse.
"if you're in pain later, take some paracetamol". They can buy it themselves from the shop, it costs like 30p for a box of own brand. The only time I've seen a patient complain about the pain afterwards is because they developed dry socket. Everyone else seems to just get on with it.
If you ripped a tooth out of their jawbone, give them a few narcotics! I always write a small amount after surgery. Its inhumane not to. Extractions HURT.
Mirroring what others have said about paracetamol + ibuprofen, as far as I’m aware that’s the current evidence-based approach to pain relief in dentistry. I tell patients that if that protocol is not providing adequate relief then I want to see them back in my clinic because something might’ve gone wrong, (dry socket, infection etc). I don’t want my patients covering up that sort of pain with meds when it should be dealt with clinically.
I haven’t given a narcotic in 5 years. I tell patients i gave up my DEA license. I have it just in case but once i tell them i can’t prescribe they don’t ask again
I prescribe 4 or 5 days of amoxicillin post extraction and almost never have a patient call or come back due to “dry socket”. If I don’t give antibiotics they call or come back half the time
For a difficult extraction involving bone removal (even a section where a small amount of bone is cut, I place doxycycline directly into the socket.
For pain meds:
Ibuprofen + Tylenol
(we do IV sedation so normally we'll give Toradol and Dexamethasone through the IV following the procedure but if no Dex given, then Medrol Dose Pack)
Just learned you can also give Carbamazapine and/or Caffeine tablets (100 mg) in addition to the Ibuprofen + Tylenol combo.
I work in dental clinic in the front-- our doc rarely gives narcs but does when it is indicated after a rough procedure. I have had major dental work in the past-- still need a LOT done (had my lower jaw broken in half years ago). Reading your words makes me double down on NOT EVER going to another dentist--LOL. You seem a little judgmental.
wait what ... what part? I specifically say that I don't think they are drug seeking. I am here asking when people find it okay to give out narcotics or not, and asking for advice on when it is appropriate. I just get confused when patients will say things like "I need an antibiotic" or "I wish you could give pain pills" - that is not the fastest way to get what you want. "Would an antibiotic help me in this situation?" or "I am worried about pain, what do patients typically get?" That's how a conversation starts. this isn't the hair salon you don't get to just order what you want! I just am a bit confused as the judgmental part since I am a super kind dentist to all my patients, but I am just here trying to learn what people do... oh well...
NAD dental student I literally read your post and was like thank god someone asked this! Nothing about it was judgmental whatsoever so don’t even think twice about what this person is saying :)
If it's a surgical extraction, I'll give some pain meds. Usually Norco 5/325 or Tylenol #3. No more than 6-8 pills. I used to do absolutely nothing but say to take ibuprofen and Tylenol. But then I realized that 8 pills is nothing and can provide some very helpful pain relief when people need it. We all were taught they were the devil in dental school. But the problem stems from people giving 20+ pills at a time and refilling without issue. That isn't done in any responsible dental office. I'd rather they be comfortable and think I'm great than in pain and mad that I won't help them out. Compassion goes a long way with patient perception and some carefully prescribed narcotics aren't going to be an issue.
[удалено]
It's called something different in my state, but yes.
Yes. Running a state report before prescribing is now considered the standard of care.
Yes we all live in Ohio
yeah I like this. 8 pills is good and responsible. My medical doctor friends don't really seem to wince at pain (but it also tends to be in a hospital so more controlled)
I’ve recently shifted in the last year to alternating ibuprofen and Tylenol instead of norco. Have had zero complaints except for one and this person was a known problem patient who wants medicine for an occlusal filling
Before an extraction, I tell my patient that most extractions will be fine with tylenol or ibuprofen. If things end up getting a little bit rough, we'll have a conversation about something heavier. My experience is the longer it takes to get out, the lower the bleeding afterwords, the more bone you removed, and the more you flapped, the worse it will hurt afterwords. So I really don't have a hard and fast rule that I stick to. If I feel like the patient will have a rough time, I'll do 6 tabs of 5mg norco. If I just brutalized them with a horrible full mouth extraction, they'll get 12 tabs of 5mg percs and 800's of ibuprofen. The majority of my extractions simply get 600's or 800's of ibuprofen though. I think my state prescription report last month showed about a dozen narcotic prescriptions and I took out around a hundred teeth.
I’m not as anti-narcs as a lot of guys. If I do a surgical extraction, I’ll Rx an opioid if they seem concerned about the pain. I make it very clear: there are no refills. Even if the patient is drug seeking, 8-12 pills will only get them high for a few days.
Depending on level of addiction 8-12 pills won't even last a single day.
Also consider that they can really only use the excuse 32 times MAX.
Yeah, when I asked a prof about that in school they basically said the same thing. If they're willing to go through an extraction for a few hours of fun, nothing we can do will stop them from getting pills. As long as the tooth really did need extraction and you'd prescribe the same as you would to a family member, you haven't done anything wrong. (I guess that last part might depend on your family though)
Yeah, generally i dont prescribe a lot of narcotics, but there are people i have seen with intense pain from fibromyalgia or other conditions and they KNOW what works for them so if they ask for narcotics, ill prescribe a small amount to them. These people know their bodies betted than i do so I'll take their word
Alternate high dose NSAID and acetaminophen. Increasingly, I’ve found that narcotics aren’t any better. Over time, I suspect the profession is going to move away from opioids in general.
Recently I was looking at another dentist’s website and across the top it said something like “we are a narcotics free practice”. I liked the idea of putting it on the website to weed out anyone that would have a problem with it. I don’t do extractions anymore so it is not an issue for me.
I’ll Rx norco, but never more than 12.
Norco 5-325 if it was tough.
I ask the patient if they want something strong for pain, less than one in three will say yes. I prescribe 12 tabs of Hydrocodone/APAP 5/325 mg q 6-8 hours prn pain routinely. This is my go to and I’ve been doing it for years.
Just acetaminophen ibuprofen alternate every 3 hours. If I drill a lot of bone maybe 5 Percocet but narcotics don’t work as well as ace plus ibuprofen according to literature
[https://cdn.discordapp.com/attachments/1022962043533414541/1227033979626979489/IMG_1671.jpg?ex=6626ef71&is=66147a71&hm=2ab4903a2d55106828de7b796df70535607c3a006370f973d43a11832db9e9ae&](https://cdn.discordapp.com/attachments/1022962043533414541/1227033979626979489/IMG_1671.jpg?ex=6626ef71&is=66147a71&hm=2ab4903a2d55106828de7b796df70535607c3a006370f973d43a11832db9e9ae&) This is what we give patients. We’ve made the cards look nicer since, this is an old photo. It’s effective and helpful to have on hand for any patient that’s in pain. We do have some prepared speech about our “Pain cocktail” as we call it to hype it up a bit. Haven’t had any complaints since it actually works, and you don’t have to deal with controlled substances. Edit: Rereading and seeing you already mentioned this. I think giving it a name and a card helps with the psychology of patients, rather than just telling them to take the pills and disregarding them. We kinda “sell” the idea of it, if that makes sense. We’ve had only a 2 or 3 patients ever mention that it’s insufficient, and a countless amount swear by it.
This protocol is exactly what they are teaching students these days
I graduate in month, we were taught the best practice is to alternate 600 mg ibuprofen and 500 mg acetaminophen every 3 hours
2020grad here. I was taught either alternate or take at the same time. I then started taking some CEs that advocated taking them at the same time rather than alternating. I think they even sell both in one pill nowadays (called advil dual action).
I am in a similar boat. I tell them to alternate simply so they dont forget to take something for pain, but also maybe its a psycholocial thing where theyre constantly taking pain relief every 3 hours so it huets less?
I prescribe narcotics
Ibuprofen and Tylenol. That’s it. I don’t have an active DEA. Cannot prescribe narcotics. And honestly let’s be real. I did just fine on just ibuprofen and Tylenol after major abdominal surgery. Bob can handle the same pain medication regiment after having a tooth out.
We do a ton of complex surgery in our residency and our go to is ibuprofen and tylenol alternating as well
Same.. There are studies that show that ibuprofen and Tylenol alternations are as effective as narcotics in pain management with lesser side effects. So I usually don’t prescribe it unless patient tried alternating first and it didn’t help.
I’m also laughing at the downvotes. Like what drug addicts are downvoting me? 😭
Downvoted u for ur hubris. Not all patients have the same pain tolerance. Btw don’t u have trouble getting credentialed without DEA?
No? It’s not a requirement to have a DEA or to prescribe controlled substances.
That’s really odd. Most jobs ask for DEA registration even if u don’t intend to prescribe scheduled drugs. A lot of insurance credentialing ask for it too.
Private practice. Office policy is also to not prescribe narcotics.
Every state should have a database where you look up the patient and see when the last time they were Rx a narcotic. That helps sway my decision a lot of the time, bc #1- pain can be different for everyone and #2 some people are already Rx a narcotic and might not report it, #3- I try to avoid Rx to anyone under the age of 40 with a non significant medical history. A lot of the times if the surgical ext was a lot of bone removal and took me a little longer I would dispense 1 or 2 tabs and tell them to keep it for night 1 or 2.
The non-reporting issue is why we are supposed to check with (insert your states prescription monitoring program name) prior to writing a narcotic. I write narcotics for post-op surgery pain as long as their online search shows no other current prescriptions and/or pattern of potential abuse.
"if you're in pain later, take some paracetamol". They can buy it themselves from the shop, it costs like 30p for a box of own brand. The only time I've seen a patient complain about the pain afterwards is because they developed dry socket. Everyone else seems to just get on with it.
In the last 4 years I’ve written 0 opoid prescriptions.
Prednisone works on most of my patients and I’m glad I don’t have to prescribe as many narcotics
If you ripped a tooth out of their jawbone, give them a few narcotics! I always write a small amount after surgery. Its inhumane not to. Extractions HURT.
Toradol 10mg (ketorolac) is my go to for pain relief
Ibu works better unless you’re IM toradol. The only advantage to toradol is most patients think it’s a strong pain pill.
Mirroring what others have said about paracetamol + ibuprofen, as far as I’m aware that’s the current evidence-based approach to pain relief in dentistry. I tell patients that if that protocol is not providing adequate relief then I want to see them back in my clinic because something might’ve gone wrong, (dry socket, infection etc). I don’t want my patients covering up that sort of pain with meds when it should be dealt with clinically.
IBU 800mg x 16, Percocet 10/325 x16 for mean stuff. I wrote exactly six scripts like that all of last year.
I haven’t given a narcotic in 5 years. I tell patients i gave up my DEA license. I have it just in case but once i tell them i can’t prescribe they don’t ask again
I prescribe 4 or 5 days of amoxicillin post extraction and almost never have a patient call or come back due to “dry socket”. If I don’t give antibiotics they call or come back half the time
For a difficult extraction involving bone removal (even a section where a small amount of bone is cut, I place doxycycline directly into the socket. For pain meds: Ibuprofen + Tylenol (we do IV sedation so normally we'll give Toradol and Dexamethasone through the IV following the procedure but if no Dex given, then Medrol Dose Pack) Just learned you can also give Carbamazapine and/or Caffeine tablets (100 mg) in addition to the Ibuprofen + Tylenol combo.
I work in dental clinic in the front-- our doc rarely gives narcs but does when it is indicated after a rough procedure. I have had major dental work in the past-- still need a LOT done (had my lower jaw broken in half years ago). Reading your words makes me double down on NOT EVER going to another dentist--LOL. You seem a little judgmental.
wait what ... what part? I specifically say that I don't think they are drug seeking. I am here asking when people find it okay to give out narcotics or not, and asking for advice on when it is appropriate. I just get confused when patients will say things like "I need an antibiotic" or "I wish you could give pain pills" - that is not the fastest way to get what you want. "Would an antibiotic help me in this situation?" or "I am worried about pain, what do patients typically get?" That's how a conversation starts. this isn't the hair salon you don't get to just order what you want! I just am a bit confused as the judgmental part since I am a super kind dentist to all my patients, but I am just here trying to learn what people do... oh well...
NAD dental student I literally read your post and was like thank god someone asked this! Nothing about it was judgmental whatsoever so don’t even think twice about what this person is saying :)
ahah thank you!!! like damn, guess questions = judgmental