In a continued effort to work toward finding the source of the opioid epidemic and the many overdose deaths sweeping the nation, experts have identified once such source that is close to home – the dentist.“Doctors have been blamed for a lot of this,” said Dr. Turner Emery, an oral surgeon in Knoxville. “You are exposed to it.  Once you are exposed you have the risk of addiction.”  Dr. Emery has been opting to administer a drug called Exparel after his patients receive extensive dental work instead of prescribing opioids in order to fight addiction.Exparel numbs the area around teeth that have been removed for up to four days following oral surgery.  Patients do not have to use opioid painkillers.“Peak times for pain after removal of wisdom teeth is the second and third day.  If you’re numb during that, you’re trying to obviate the need for narcotics,” said Emery. “We’ve had just a few people where they’ve had to take a narcotic or two, but in general they’re simply taking over the counter medicines.”

Photo by Yingpis Kalayom on Unsplash

Dr. Emery has used the drug since November 2017 and since that time only three of the seventy people who have used it had to take additional prescription medication to help with teeth pain following surgery.15-year-old Elli Kvamme had her wisdom teeth pulled and her parents allowed her to use Exparel to recover so she could avoid taking any opioids.  She found it to work just as well.  “It was an injection in each molar and it numbed it for two to three days,” said Kvamme. “I didn’t have to take prescriptions.  I just had to take Advil.  It made me feel more like myself and I didn’t sleep a lot during the day.”“She was just taking over the counter Ibuprofen and kept saying she felt normal,” said her mother, Audrey Kvamme. “The idea of not needing to take a narcotic, and the side effects that go with that and the potential of side effects down the road, I thought that was a great idea to try.”Deborah Crouse with the Metro Drug Coalition (MDC), explained, “A prescription pill can be as deadly as a loaded gun to someone if it gets in the wrong hands.  A lot of adolescents are typically first prescribed an opioid during a surgery or wisdom teeth, a sports injury.”Unfortunately, not all insurance companies currently cover Exparel and it costs about $200.  However, this landscape may change as more and more doctors are looking for ways to help fight the crisis.  It’s all in getting the word out there.  “The limitations are that we’ve got some insurance companies that are a little hesitant to cover it,” said Emery. “It works really, really well and we’ve had some good results with it.”In late March 2018, The American Dental Association (ADA) announced a new policy on opioids supporting mandates on limits to prescriptions and continuing education.  According to the policy:

• The ADA supports mandatory continuing education in prescribing opioids and other controlled substances.

• The ADA supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the Centers for Disease Control and Prevention evidence-based guidelines.

• The ADA supports dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids and deter misuse and abuse.

The policy was the first of its kind.  “As president of the ADA, I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” said ADA President Joseph P. Crowley, D.D.S. “This new policy demonstrates ADA’s firm commitment to help fight the country’s opioid epidemic while continuing to help patients manage dental pain.”

Sources:

Dentists use alternatives to opioids to fight addictionAmerican Dental Association Announces New Policy to Combat Opioid Epidemic