Pain Management & Dentists’ Role in the Opioid Crisis

By Peter Chemello, DDS

Medical professionals across the country are working to qwell the opioid epidemic facing the Chicagoland area and the rest of the nation. Working on a local level is key in addressing the problem. The solution starts with changing the way we practice. As dental professionals, we need to continue to work hand-in-hand with other clinicians to evolve the way we treat patients to curb excessive pain medication usage. Our role is three-fold: communicating patient histories, exercising control in dosage length and staying on top of science and alternative ways to manage pain. Continuing education is a cornerstone of this approach, such as last month’s Chicago Dental Society’s Midwinter Meeting, which annually attracts nearly 30,000 dental professionals from around the nation. Together, we can make important steps to reduce the impact of this issue in our communities in the Chicago area and across the state.

Pain management is central to my work as an oral surgeon. Pain medication depends on each case. It is subjective, not objective: what is painful for one patient may not be painful to another. As a doctor, my role is to manage that pain so that recovery is as speedy and pain-free as possible. In addition to making patients more comfortable after surgery, medication is also critical in the healing process – reducing inflammation and supporting the transition to full activity.

I know my patients’ dental histories, but prescriptions can come from any number of clinicians. Tracking medication history is key in identifying those at-risk for prescription abuse. Tracking medication history has been made easier by the Illinois Prescription Monitoring Program and similar programs run in other states. By logging on, I can see a patients’ full prescription history and identify if they’ve been given pain medication from other providers. By having that information at my fingertips, I’m able to be better informed and prescribe the right treatment plan for the patient I’m working with.

Volume control is another important step. In my practice, we give patients the smallest amount of medication possible. Our limit is a three-day supply of pain medication. By limiting the supply, we are guaranteeing a faster check-in with our office, which allows us to manage the next steps in their recovery, often without opiates.

The science of pain management has also advanced for the oral surgery procedures I perform on a regular basis. We know that alternating doses of commonly used over-the-counter medication -- ibuprofen and acetaminophen -- often works as well as opiates in managing pain after oral surgery. Combined with close monitoring of recovery including changing dressings and supporting tissue healing, we are often able to eliminate opiates from treatment plans all together. This is why it’s so important to stay on top of continuing education around the issue. Professional dental associations, like the Chicago Dental Society and the Illinois State Dental Society, play a critical role in developing courses on the latest science in pain management for dentists across the state. It is incumbent upon me, and my peers, to stay on top of the latest alternative pain management techniques to decrease access to opiates.

The opioid crisis will continue to be an issue at the forefront of our profession as we work to decrease addiction to narcotic medications nationwide. Here in the Chicago metropolitan area, the solution starts with individual clinicians in the way that we practice and manage patient recovery. Dental professionals are a central part of making strides in our communities – not just for our patients’ oral health, but to improve their overall health. We are dedicated to continuing to work with clinicians across the care continuum to control the access to these drugs while maintaining quality of care and patient outcomes.

Dr. Chemello is a Chicago Dental Society member and is an oral surgeon practicing in Arlington Heights.