By Anne Blythe
Holiday breaks for many teens and college students might often include a bit of bah humbug in a dentist’s office.
Many young people schedule wisdom teeth extractions then so they can have a few days to recover at home without missing classes or work.
The experience can be one of the more painful initiations into adulthood.
It also can be an introduction to opioids, a hazard that North Carolina’s attorney general Josh Stein and oral health care providers now are trying to make sure the young patients and their parents fully understand.
Dan Cook, an oral surgeon based in Denver, N.C., used to send patients whose wisdom teeth he had just pulled out the door with prescriptions for opioid pain medication to last four days.
That added up to about 21 pills per patient, Cook told media crews gathered several weeks ago in the lobby of a south Charlotte Carolinas Center for Oral & Facial Surgery.
Some used the addictive painkillers, Cook said.
Others used some, but not all.
Some never even opened their bottles and stowed the unused pills in medicine cabinets or other accessible places as the opioid crisis raged in North Carolina.
Now as dentists in this state join other health care providers squaring off against the deadly opioid epidemic, they’re looking for different ways to help patients manage pain after wisdom teeth extractions and other oral surgeries.
They also have launched an effort to spread the word among their peers about opioid alternatives.
Stein says one of his missions in his first three years in the state attorney general’s office is to travel the state, listening to an array of people to help him understand how to push down the number of opioid overdose deaths in this state.
‘Talk to your patients’
In 2017, according to data collected by the state Department of Justice, 2,000 North Carolinians died from such opioid overdoses. The state lost 13,169 people between 1999 and 2017 to unintentional opioid overdoses.
On average, Stein often says, North Carolina loses five people a day to the epidemic.
“About 30 percent of the time, a teen’s first opioid prescription comes from a dentist,” Stein said at the Charlotte news conference. “And when young people take opioids before high school graduation – even when safely and appropriately prescribed – their risk of misusing opioids in the future goes up 33 percent. That is why it is so important that dentists talk to their patients about these risks. I applaud North Carolina’s dentists and oral surgeons for taking this important step to confront the opioid crisis.”
Cook, the immediate past president of the North Carolina Society of Oral and Maxillofacial Surgeons, talked about changes he has made in his office and encouraged a mother whose two daughters he had treated to describe the differences.
Heather McElroy’s older daughter had her teeth pulled several years ago and was prescribed and used opioids to ease her pain.
McElroy recalled it as an unpleasant experience.
Her younger daughter had her teeth extracted weeks ago and made it through the experience using ibuprofen, an anti-inflammatory analgesic that dentists and oral surgeons are now recommending more as a better line of attack.
The procedure occurred on a Wednesday and McElroy’s daughter was back at work two days later on the following Friday.
Cook no longer sends everyone along their way with opioid prescriptions. Instead he suggests regiments of acetaminophen or ibuprofen and ice packs.
“Now we spend more time telling them there will be pain,” Cook said of his patients. “It’s surgery.”
What about Exparel?
Cook also advocated for wider acceptance of and broader use of Exparel, an anesthetic approved by the U.S. Food and Drug Administration in 2011 for injection before surgery to manage pain in the wounds during operations.
The analgesic can numb the injected area for up to 36 hours.
But the non-opioid drug’s path to other off-label uses has been one that has drawn advocates and critics.
The drug, manufactured by Pacira, contains bupivacaine, a nerve impulse blocker often given as an epidural during labor or spinal surgery.
Exparel is devised for longer effectiveness, but that also means it won’t clear out of the body as quickly, leaving researchers to ponder the long-term impact of such use.
Over the years, though, the FDA has broadened its approval for off-label use. Now prescribers and others hope to persuade insurers to embrace its use and provide reimbursement.
Spreading the word
As part of their plan to lessen the prescribing of opioids by dentists, the state Division of Public Health has prepared a pamphlet to be distributed in waiting rooms and other prominent places across the state.
In addition to offering alternatives to prescribed opioids, the pamphlet instructs people how to use them safely and how to dispose of unused opioids and lower the risk that they will fall into the wrong hands.
“Dentists play a key role in addressing the opioid crisis,” Sarah Tomlinson, the state dental director and oral health section chief for the Division of Public Health, said at the news conference. “We care about patient safety. Our goal is to help patients understand that most dental procedures do not require opioids for pain management and educate them on how to best prevent misuse if they are prescribed opioids.”
How we reported this story:
- Traveled for several hours to a news conference.
- Asked follow-up questions at and after the event.
- Used publicly available information and statistics from government agencies.