Parkview Dental Care - David Bertagna, DDS
In a recent newsletter, the fact that our bodies are an amazing creation was discussed. It centered on the ability of the body to be able to repair itself. Nothing manmade is able to accomplish this feat. It was pointed out that all tissue repairs in the human body begin with the process that is called inflammation.
One of the most obvious signs of inflammation is pain. The other signs of inflammation include swelling, redness, warmth of the area, and loss of function. It was pointed out that inflammation can be divided into two types, acute inflammation and chronic inflammation. The pain associated with these two types of inflammation typically respond to medications in different ways.
Acute inflammation usually responds well to a class of medications called NSAID (non-steroidal anti-inflammatory drugs). These drugs include aspirin, ibuprophen (Advil, Motrin), naproxen (Alieve), and Excedrin (combination of acetaminophen, aspirin, and caffeine). These medications help control the human bodies' response to the trauma that caused the inflammation initially.
Prolonged inflammation, or chronic inflammation, results when acute inflammation transitions from tissue repair to the simultaneous destruction and healing of the tissue involved from the initial trauma. As was pointed out in the previous newsletter, chronic inflammation is almost always accompanied with tissue destruction.
When this cycle of tissue repair/tissue destruction occurs, anti-inflammatory drugs become less effective. This is probably the result of the human body's immune system transitioning into different cell types that are needed to remove the necrotic (dead) tissue from the site of the initial trauma. These cells do not respond to the NSAIDs.
These cells do respond to a class of drugs described as opioids. Opioids are drugs that act on the human cells natural receptors in the nervous system that respond to morphine-like chemicals. They mimic the natural pain control chemicals produced in the body. These medications include codeine, hydrocodone, oxycodone and morphine.
These are powerful medications that can treat the pain associated with chronic inflammation. Unfortunately, these medications are the most commonly abused drugs in the United States. They are highly addictive by nature and people become dependent not only because of the relief from pain, but also because they interact so effectively with the natural receptors of the nervous system.
This interaction eventually damages the natural receptors so they are unable to respond to either the naturally produced chemicals or the opioid medications. Opioid drug abuse has been getting much attention from law enforcement, media outlets, politicians, and of course, health professionals. The abuse of opioids, the related addiction and even death that has resulted are real issues that health professionals are attempting to come to terms with.
The problem with opioids is that it doesn't take long to become addicted. The need to prescribe narcotics should be very rare. For the vast number of dental patients, there are non-opioid options for pain control. Narcotics are not the best drug for postoperative dental pain because they are not anti-inflammatory.
Studies have shown that the use of an anti-inflammatory in combination with acetaminophen can suppress pain better than either one alone. In fact, they showed that in many instances, the pain suppression was better than the opioids. A dental patient should be able to achieve adequate pain relief without the use of narcotics.
Besides the high rate of growing dependent on narcotics, their use poses a problem to people who are taking other medications for various health issues. There are many drugs that interact with narcotics that could cause additive side effects. However, people who are unable to take NSAIDs may benefit from the short term use of narcotics for most of the pain experienced with dental procedures.
The most important way to avoid the need for painkillers is preventive dental care which prevents gum disease and tooth decay in the first place. And if there is a dental problem, acting expediently could limit the need to use narcotics. Until science can achieve an effective way to treat dental pain in a safe and consistent way, the proper use of pain relieving medications is imperative.