The challenges of both acute and chronic pain management have certainly caught the attention of healthcare providers across the country as the opioid pandemic has demanded more responsible prescribing practices. As training and awareness in the prescription of opioids leads to new frameworks for the management of pain, prescribers have become increasingly reliant on non-narcotic strategies.
Dental procedures—and particularly dental surgery—typically require both pre-procedural and post-procedural pain protocols, and in the past, dentists have been lenient and generous with the prescription pad. Unfortunately, it has resulted in the same addictive outcomes seen in the healthcare industry at large, and practices are increasingly facing the need to approach pain with a priority on safety. Complete freedom from pain through over-prescribing of opioids is no longer a viable solution, and dentists must instead focus on creating responsible and effective plans to manage pain appropriately.
Common Types of Jaw Pain
While most dental procedures come with at least a little mild discomfort, some result in considerable pain that requires ongoing treatment. Surgeries and complications can cause inflammation, incisions and extractions need time to heal, patients experience muscle fatigue, and there are a host of possible post-surgical issues.
Here are some common dental issues that may require significant medication protocols to manage pain.
All teeth have nerves underneath the outer layers of enamel and dentin. Occasionally, due to a deep cavity or extreme biting force, a tooth nerve will die, leaving necrotic tissue inside the tooth. As the body recognizes the infected issue, it builds up an immune reaction which is typically referred to as a tooth abscess. Antibiotics can help alleviate the symptoms of pain and swelling, but only a root canal procedure or a dental extraction will completely resolve a necrotic tooth.
Pulpitis is an inflammation of the pulp of the tooth that can cause severe pain when exposed to things like hot or cold. There are two types of pulpitis: reversible and irreversible. Reversible pulpitis is characterized by pain that resolves when the stimulus is removed, and irreversible pulpitis results in discomfort that is constant and ongoing.
On occasion, pulpitis can be caused by the preparation or drilling of a tooth during the dental procedure itself. If it doesn’t subside within a couple of days following the procedure, another visit to the dentist is warranted as well as further pain management considerations.
Temporomandibular Disorder (TMD)
Frequently referred to as TMJ, temporomandibular disorder refers to pain emanating from the masticatory system. This includes the temporomandibular joint, the muscles of mastication, and the teeth.
TMD can often be misdiagnosed, as it can cause diffuse jaw pain, ear pain, and tooth pain that is difficult to localize. Dentists are well equipped to differentiate TMD pain vs. other types of oral pain, and can mitigate the symptoms with a variety of treatments including specialized mouth pieces, orthodontics, and tooth adjustment. Physical therapy and chiropractic treatment have also proven to be good methods to treat patients suffering from temporomandibular disorder.
Dry sockets can occur following a tooth extraction when the blood clot in the empty socket is disrupted. A dry socket is bone irritation, and can cause deep and intense jaw pain after dental work radiating from the site of the extraction down the side of the face.
Because dry sockets are caused by the disruption of a protective clot, patients should be instructed to avoid any sucking motions that irritate the site. Dentists may decide to use dry socket paste to alleviate the bone pain before medication is prescribed.
Past Approaches to Post-Procedural Pain
Past approaches to managing pain were often driven by the consideration of pain as the 5th vital sign. This resulted in prescribing practices that were designed to largely alleviate or eliminate a patient’s experience of pain.
Unfortunately, while opioids are extremely effective pain remedies, their addictive properties made relatively simple dental procedures a potential entry point for long-term addiction. Little consideration about reasonable pain expectations and root causes—in addition to limited counseling on proper opioid usage—created a perfect storm of routine dental prescriptions and the enablement of patient addiction.
Current Best Practices
Today, responsible management of dental pain means having a larger conversation with patients about reasonable post-procedural expectations, alternative management strategies, and deliberate, informed use of pain medication. Jaw pain after dental work is an inflammatory process, and it’s reasonable for patients to experience some degree of discomfort after a procedure.
Preparing a patient begins with coaching them about the procedure and what kinds of pain to expect. Advice about at-home strategies for pain management like avoiding hot or cold foods and drinks, application of ice packs, and which activities to limit all empower patients to become active participants in their own comfort.
Supporting non-opioid pain protocols like steroids for inflammation and medications like acetaminophen and ibuprofen are often enough to reduce pain to tolerable levels. A lot of this can be handled over the phone without the need for pharmaceutical oversight, and should additional medication become necessary, there are a variety of suitable opioid alternatives to consider.
Finally, clear guidelines for follow ups can be extremely helpful for patient decision making. Simply knowing the difference between common and concerning symptoms can be enough to avoid unnecessary office visits, and guidance for adjusting doses on non-opioid pain medications can mitigate temporary increases in discomfort.
Keep Your Practice Current with Premiere
Managing jaw pain after dental work sometimes requires powerful pills, but in modern practice there are a host of non-opioid alternatives and strategies that are improving overall health outcomes. However, because dental practices are often privately owned and operated, disseminating information, establishing industry-wide best practices, and accessing continuing education remain significant challenges for the more than 200,000 dentists currently working in the U.S. today.
Premiere is placing itself at the forefront of dental continuing education, offering an interprofessional perspective on complex healthcare challenges that involve a wide range of health disciplines. Our expert online content is making it easy for dental professionals to stay compliant, informed, and up to date on the latest best practices and industry insights.
Course like This is Such a Pain in the…Mouth! How to Treat Oral Pain and the Role of Opioids developed by Grant Hunsicker, DDS, General Dentist, Hunsicker Family Dental, and Megan Arbour, PhD, RN, CNM, CNE, Associate Professor, Frontier Nursing University deliver key content for dental license renewal requirements that will ensure you give your patients the best possible care. All content by Premiere is created by leading industry professionals, and makes advancing your career and practice as easy as the click of a button.