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Letters: Think twice about prescribing

April 15, 2019

As a practicing periodontist with over 40 years of clinical experience, the opinions expressed here are based upon my own patient population, as well as clinical research examining the efficacy of nonopioid pain medication as an alternative to narcotics.

On a daily basis over the decades, I have performed surgical extractions, sinus augmentations, dental implants and various types of periodontal surgeries without the use of an opioid. After reading the research and hearing lectures on the benefits of nonsteroidals, I stopped prescribing opioids in 2005. I have had little or no patient feedback indicating that the nonsteroidals, which are often combined with acetaminophen, had failed to provide them adequate pain relief. One particular patient who said that nonsteroidals don't work for her, resulted in me prescribing Meloxacam, telling her that this is a powerful medication that she had never taken. Lo and behold, she reported back that it provided her with more than adequate pain relief.

Medicine and dentistry must move to an evidence-based treatment. Colleagues in medicine and dentistry have often been influenced to prescribe opioids in order to satisfy a patient's desire, requiring the practitioner to prescribe them with opioids when it was not necessary.  Additionally, as one physician told me, "They come to me in pain and they want a prescription that will relieve it. If I tell them to take three Advil and two Tylenol they will think the visit was of no value. It would hurt my practice's reputation."

I have experienced, sadly, the death of five of my patients' children due to opioid overdoses and have literally dozens of patients whose children are currently fighting addiction.

I would strongly urge all of my colleagues to think not twice, but multiple times, before prescribing a narcotic, and be aware that it is not the best medication for treating dental pain.

Victor M. Sternberg, D.M.D.
Briarcliff Manor, New York