Advancements in Pain Management
Q&A with Scott C. Dickinson, DMD
Inside Dentistry interviews Scott C. Dickinson, DMD, who has maintained an active general practice in Pensacola, Florida, since graduating from the University of Pennsylvania School of Dental Medicine and completing his AEGD in the United States Army
INSIDE DENTISTRY (ID): What advice can you offer to fellow practitioners regarding the goal of increasing patient comfort through education about pain management?
Scott C. Dickinson, DMD (SD): The advice I would offer to practitioners is twofold. First, patient education about pain management primarily entails helping patients understand that we want to manage their pain pre-, peri-, and postoperatively, whether for emergency care or a scheduled procedure. Clinicians should understand the importance of premedicating their patients, not just prophylactically, but also with medications that are available to limit inflammation and other procedural insults. They should also understand the importance of selecting proper anesthetics to be used during the procedure to provide maximum anesthesia and comfort for the patient. Postoperatively, the clinician needs to follow the patient with appropriate medicines to manage all of the insults and effects of the procedure. A well-informed patient understands that their clinician is dedicated to this level of care.
Second, I advise clinicians to educate patients about the efficacy of non-opioid and non-narcotic medications that are available. There is a widespread misconception among the general population that over-the-counter pain relievers are not as strong as opioid analgesia. However, many drug studies have demonstrated the effectiveness of over-the-counter medications, such as the combination of naproxen and ibuprofen in conjunction with acetaminophen. We need to help patients understand that pain can be properly managed without the opioid class of medicines.
ID: How can a dentist's approach to infection control affect the provision of effective pain management?
SD: Because the mouth has a lot of bacteria in it, the potential to transmit infection is high, and the inflammation and histamine response resulting from infection increases our patients' pain. Staying on top of infection control limits our patients' exposure.
Dentists also need to be aware that, inevitably, they will introduce an infection, so postprocedural infection control is crucial, even if just with a light antibiotic, when indicated.
ID: Have new modalities for the administration of analgesics improved outcomes?
SD: Yes. One of the challenges that we currently face is that new modalities are being presented in a regulatory fashion as access to some of our analgesic medicines is being limited. This is a move in the right direction; however, clinicians are sometimes being forced to work around the medicines available. Truthfully, the use of over-the-counter combination medicines will prove to be incredibly effective as they gain popularity.
ID: What have been the most important advancements in retraction and their effects on patient comfort?
SD: The most important advancements have come in three areas. First, when compared with some of the conventional braided cords that were packed subgingivally, the newer retraction methods are fantastic in managing the tissue, obtaining hemostasis, and helping maintain a dry field. Second, impression materials continue to advance. Some vinyl polysiloxane materials are so hydrophilic that they break the surface tension on preparations and actually push or advance the impression materials down around the margins and underneath the sulcus and the gingiva. Third, the field of fixed prosthodontics is starting to trend toward all-ceramic restorations, and zirconia and some of the newer glasses and porcelains are now available for milling. With all three of these technological advancements, the management of soft tissue and retraction becomes easier, more predictable, and much less invasive.
ID: What do you consider to be the biggest, recent breakthrough in pain management?
SD: The biggest breakthrough has been the adoption of this more comprehensive approach that looks to manage our patients' pain from beginning to end. Practitioners and clinicians are becoming much less reactionary and much more proactive, knowing that they will be performing procedures with known outcomes and formulating plans to allow patients to move forward with their daily lives without interruption.
Additionally, in the past 10 to 15 years, the advancements in sedation and nitrous oxide techniques have been great. These techniques are relaxing patients. We are getting more profound anesthesia. The body is perceiving less insult and injury during procedures, so the need for postoperative pain management is much less.
Scott C. Dickinson, DMD