Physician Personas: Oral Surgeons

Part
01
of nine
Part
01

Oral Surgeon Persona: Pain Management Options

Three primary methods oral surgeons use to find out about new options for mitigating patient pain are continuing education, which includes on-demand courses, live webinars, and interactive online tutorials with experts in their field; conferences; and professional journals.

AMERICAN SOCIETY OF ORAL AND MAXILLOFACIAL SURGEONS (AAOMS)

  • AAOMS is a professional organization that represents oral and maxillofacial surgeons in the US.
  • AAOMS members are bound to adhere to national standards through continuing education.
  • The organization offers its members continuing education (CE) in several formats, such as live webinars, CE on demand, and OMS knowledge update (OMSKU). Live webinars provide a platform for members to learn from professionals of other associations, ask questions to expert speakers, and interact in the discussion at hand. CE on demand offers online courses and access to webinars and programs at the members' convenience. Lastly, OMSKU is an innovative way to achieve continuing education. It provides members with online interactive tutorials written by professionals of the OMS field and other experts in various fields.
  • The organization also holds annual meetings and scientific sessions and exhibitions for its members.

NATIONAL INSTITUTE OF HEALTH (NIH)

  • NIH encourages practitioners to collaborate with other agencies to share resources and education about the latest and most up-to-date scientific findings to reduce the dental community's reliance on opioid as a pain reliever, which can potentially lead to opioid abuse and addiction.

THE JOURNAL OF ORAL and MAXILLOFACIAL SURGEONS

AMERICAN COLLEGE OF MAXILLOFACIAL SURGEONS (ACOMS)

RESEARCH STRATEGY

To determine three to five primary methods oral surgeons use to learn about new options for mitigating patient pain, we began by searching for methods of how oral maxillofacial surgeons (OMS) learn about new developments and information in their field by searching websites such as the National Institute of Health, Research Gate, and the CDC. The results were not satisfactory as they were more focused on how to mitigate post-op pain rather than how oral surgeons learn of new options for mitigating pain. However, the National Institute of Health did explain the importance of dental professionals obtaining the most up-to-date scientific information when making decisions in pain management.

Next, we focused on OMS associations and dental journal websites, such as the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the Journal of Oral and Maxillofacial Surgeons. We found that the OMS learn mainly through continuing education, attending conferences, and professional journals. Continuing education (CE) is required to maintain state standards. CE may exist in many formats, such as live webinars, on-demand classes, and live events. On-demand classes and courses allow the professionals to access materials on their own schedule while live webinars and events allow them to collaborate with their peers and experts in their field and other areas such as scientific researchers and pharmacists. Attending conferences allow the OMS to visit exhibits and find out about the latest innovations in technique, tools, and medications. Conferences also give them opportunities to network with other professionals. Finally, the Journal of Oral and Maxillofacial Surgery publishes a monthly publication providing knowledge of the latest scientific breakthroughs, research, and future explorations in the profession.
Part
02
of nine
Part
02

Oral Surgeon Persona: Technology Adoption

While we were able to locate information regarding oral surgeons' adoption rate of new technology, we were unable to find statistics surrounding evidence of any correlation between their rate of technology adoption and the likelihood that they'll use new products in their medical practice in the United States — this is because most of the information was qualitative in nature and the surveys and reports mainly focus that digital technology has become more prevalent in oral surgery. The healthcare technology used to treat and operate on the face, mouth, and jaw is constantly evolving and changing.

KEY FINDINGS:

Oral surgeons are typically the early adopters of new technology

  • According to Technavio, the growing adoption of 3D printing technology by dental professionals like dental surgeons has a positive impact on the market — this contributes to its growth significantly over the forecast period.
  • New product launches is another aspect that is boosting the market growth — the North American region like the United States has led the market in 2018 with more research and development investments in healthcare technology to improve its existing products and developing innovative products.
  • According to NYU College of Dentistry reports, the technology which is the application of scientific knowledge for practical purposes is and always has been a core component of dentistry.
  • Louis Rafetto, President-elect of the American Association of Maxillofacial Surgeon says Oral Surgeries remain same but the way and the method to do it has changed — the healthcare technology used to treat and operate on the face, mouth, and jaw is constantly evolving and changing.
  • Oral surgeons have some different needs in IT services and support but they would always need reliable and updated equipment with appropriate HIPAA compliance and patient-friendly software for oral surgery.
  • Olulu reports that digital technology has become more prevalent in oral surgery — this is because the acceptance of new technology between senior and junior surgeons has continued to grow.
  • Out of all generations such as Millennial, Boomer, and Gen-X surgeons; millennial oral surgeons believe in the value of innovation; they are more likely to adopt new techniques and technology in their surgical procedures.
  • Millennial oral surgeons are protective of their leisure time — they strongly believe in using their technology to reduce their overall workload.

Correlation between the rate of technology adoption and the likelihood that they'll use new products in their medical practice:

  • The Healthcare authorities’ like healthcare organizations and hospitals incorporate themselves into the process of digitization — the team members whether they are digital native or immigrant are treated as valuable assets and have been trained regularly so that new products can be used in their medical practice.
  • To remain competitive in the healthcare industry, digitally native millennial and digitally immigrant senior oral surgeons have collaborated to adopt technology in their medical practice with the creative ways to engage with patients, staff, and referring dentists.
  • The surgeons and their team members have pursued innovative and digital solutions to foster practice growth and to expand their market share in implant dentistry.
  • The digital technology is a key feature that has positively influenced the adoption of digital technology in the broader community of interest — more dental schools are training students with the introduction and familiarity of advanced technology. Thus, the traditional barriers within dental schools are rapidly eroding.
  • The familiarity of prosthodontist faculty with digital technology is a key feature and has become an important part of the curriculum.
  • This has positively influenced the adoption of digital technology in the broader community of interest.
  • Most dental surgeons in the United States specifically in Miami region are equipped with new technology like digital X-rays that helps dentists to repair cavities without drilling and allows zooming-in on a live image and can assess the situation better.

Statistical Data on adopting new technology:

  • According to a survey conducted by American College of Prosthodontists, dental educators are encouraging using more advanced technologies with the introduction of 92% use of 3-D radiography, 69% use of intraoral scanners in contrast to 56%, and 32% of private practice prosthodontists.
  • At the clinical level, the three most widely adopted new technologies are digital radiography — 91%, cone-beam CT — 85%, CAD/CAM indirect restorations — 58%, and virtual surgical guides and implant placement — 30%.
  • Approximately 50% of post-graduate oral programs included aspects of digital denture technology in their program curriculum — however, most educators plan to include digital denture fabrication in their curriculum by 2020.
  • As per the survey conducted by the American College of Prosthodontists, 65% of prosthodontists utilize advanced digital dentistry in their practice and approximately 50% of American College of Prosthodontists members have adopted this.
  • Thus, we conclude that oral surgeons are quick learners in adopting New technologies in the US.

Research Strategy

To locate how quickly oral surgeons in the United States typically adopt new technology and the correlation between this adoption rate and their likelihood to use new products in their medical practice, we began by combing through government websites and market reports specific to oral surgery like BusinessWire, Grandview Research, and Market&Market reports. We hope to locate information on the latest technology used in oral surgery. While we were able to locate information on dental surgical equipment market that is expected to grow at a CAGR 6% at the global level and the North American region has led the market in 2018, followed by Europe, and APAC — there was no statistical information specific to the United States market that was available. We went further to leverage information in media articles like US news, NOVA computer solutions, and Medical News Today. The sources mentioned the technology used to treat and operate on the face, mouth, and jaw is constantly evolving and oral surgeons are quick learners and are adopting technologies in their surgery procedures, but there are no hard data available to support the claim.

Next, we scoured through Healthcare Forums and Industry Expert reports like the American Hospital Association, HealthCareForums, and NYU College of Dentistry. The idea was to look for the interviews and opinion of healthcare expert and to get some quantitative information on the number of technology used by oral surgeons. The result of this strategy was referencing application of technology, scientific knowledge for practical purposes which has always been a core component of dentistry. The sources also mentioned that the three most widely adopted new technologies is digital radiography (91%) and cone-beam CT (85%), CAD/CAM indirect restorations (58%), and virtual surgical guides and implant placement (30%). But there was no specific information available that conclude the correlation between adoption rate and their use in medical practice.

Our research team change gear, as there was no pre-compiled information available, we resorted to triangulate the requested information from available data points. The idea was to check the persona of an oral surgeon if they are technology savy or whether they quickly adopt the technology in their practice in sources like Ollu.com and data.gov.in. The sources mentioned that millennial surgeons believe in the value of innovation, and are more likely to adopt new techniques and technology which proved that they are technology Savy. No hard data could be found, the likelihood to use new products in their medical practice could not be correlated. Thus, the triangulation strategy could not be done due to limited data.

Lastly, we broadened the scope of our research and looked for the information specific to North American region if there is any mention of technology adoption and its use in medical practice by oral surgeons are mentioned in sources like North American Healthcare Forum, Business Research Company, Reuters, and Future Insights Market. But all these reports give information at the global level and the information was behind the paywall so the North American Market could not be analyzed with limited information.
Part
03
of nine
Part
03

Oral Surgeon Persona: Pain Management Opinions / Hospitals

Detailed research could not uncover direct information regarding the general opinion of oral surgeons around pain as it relates to patients' discharged from the hospital. Below are the helpful findings uncovered and strategies utilized.

HELPFUL FINDINGS

  • Patients' discharge after oral surgery varies per individual and based on the complexity of the surgery.
  • Various oral surgeries are associated with different pain intensity and other medical complications.
  • According to WHO, pain intensity can be categorized as mild, moderate, and severe.
  • After oral surgery, patients are placed under medical observation to ensure their stability before discharge.
  • The major determinant of patient discharge after oral surgery is patient stability and to ensure that their vital signs are within the normal range.
  • A report revealed that patients are discharged after oral surgery before the effect of the anesthesia elapsed.
  • Also, patients are advised to report to the hospital immediately if any medical complications showed up such as severe bleeding.
  • After patients have gone through the recovery phase, patients are discharged with pain relieve prescription to manage the post-oral surgery pain after the anesthesia effect has elapsed.
  • A report revealed that the majority of patients present with mild to moderate pain after oral surgery, while others present with moderate to severe pain following oral surgery.
  • Opioid medications are generally prescribed for patients with moderate to severe pain, following oral surgery.
  • Non-opioid medications are generally prescribed for patients with mild to moderate pain, following oral surgery.
  • Some examples of opioid medications include hydromorphone, codeine, tramadol, among others.
  • Also, some examples of non-opioid analgesics include acetaminophen, gabapentin, ibuprofen, naproxen, among others.
  • A report revealed that there is a high prescription of opioid analgesics in various surgical specialties, including oral surgery for the management of post-operative pain.
  • In conclusion, as a result of the advancement in medicine, the anticipated pain intensity of patients after oral surgery does not influence patients' prolong admission in the hospital due to the availability of various analgesics that can be used by patients at home to mitigate the severity of pain, as directed by the doctor.

RESEARCH STRATEGY

To address the research request, our initial approach was to search through research databases and scientific reports such as NCBI, ResearchGate, Academia, ScienceDirect, among others to identify the general opinion of oral surgeons around pain as it relates to patients' discharged from the hospital. This search was not successful in identifying the required information. Information we were able to retrieve here was basically about various studies and reports regarding pain management regimen after oral surgery.

Next, we searched through health-related specialized agencies databases and oral surgeon association websites such as World Health Organization (WHO), American Association of Oral and Maxillofacial Surgeons (AAOMS), among others to identify the general opinion of oral surgeons around pain as it relates to patients' discharged from the hospital. Again, this search was not successful in identifying the required information. Information we were able to retrieve was related to the various classification of pain following oral surgery.

Next, we searched through various published medical reports and articles on websites such as Mayo Clinic, Medscape, Healthline, among others to identify the general opinion of oral surgeons around pain as it relates to patients' discharged from the hospital. This search was not successful in identifying the required information. Information we were able to retrieve here was related to the various classification of pain after oral surgery, general information on patients' discharge after oral surgery, examples of pain-relieving medications, among others.

Lastly, we expanded the scope of our search beyond two years to identify any mention of the general opinion of oral surgeons around pain as it relates to patients' discharged from the hospital. Here, we were able to identify detail information regarding oral surgery procedures, information on pain classifications, among other things. We could not identify the required information through this strategy.

Lack of retrieval of direct information regarding the general opinion of oral surgeons around pain as it relates to patients' discharged from the hospital could be as a result of lack of publication of such information on public data.






Part
04
of nine
Part
04

Oral Surgeon Persona: Pain Management Costs

The cost of pain medication products after an oral and maxillofacial surgery can be high. Various approaches can be used to manage acute pain to prevent transitioning to chronic pain, thus increasing costs of treatment.

GENERAL OPINION OF ORAL SURGEONS
  • According to the Journal of Pain Research article, The Challenges of Pain Control and The Role of The Ambulatory Pain Specialist in The Outpatient Surgery Setting, it is important to consider lowering costs without sacrificing the patient's safety.
  • Transition of pain from acute to chronic causes medical and economic burdens.
  • It is important to fully control acute pain with multi-modal approaches to preemptively prevent chronic pain.
THE IMPACT OF COST OF PAIN MEDICATION ON PHYSICIAN'S DECISION
  • Some physicians may not include effective analgesics on their formularities because their costs are high, high co-payments and need for authorization.
  • A recent survey of a large physician practice, shows that many physicians are unaware of cost drivers or do not think they need to participate in issues concerning cost in their healthcare institutions.
THE IMPACT INSURANCE ON DOCTORS DECISION
  • A study by the NBCI on the influence of the insurance status on surgical treatment of acute spinal fractures shows that patients with insurance were more likely to undergo surgery than the uninsured.

Part
05
of nine
Part
05

Oral Surgeon Persona: Pain Management Confidence

The confidence level of oral surgeons around how pain works and its treatment is not yet fully 100%. They have a general understanding but based on clinical studies, research, and surveys, it appears that some are still using the traditional way of treating pain using opioid prescription because they have minimal awareness of its negative effect.

OVERVIEW

  • In the United States, one of the most common surgeries in the mouth is tooth extraction or the removal of the wisdom teeth. Among all tooth removals, 95% is represented by tooth extraction.
  • On average, about 3 million people was treated by oral surgeons for tooth extraction, mostly under 25 years old.
  • Historically, opioid-based medicines are given by oral surgeons to their patients as the first-line treatment of pain. This has become the standard method of prescription since the 1970s.
  • Patients who get their first exposure to opioid due to dental surgery are young adults aged 15 to 24.
  • A recent study published by the American Dental Association (ADA) in their journal JADA, indicated that the use of Ibuprofen together with nonsteroidal anti-inflammatory drugs (NSAIDs) is better than using opioids because of the dangerous effects in patient's health of prolonged use of opioid.

ORAL SURGEONS' ROLE IN THE PATIENT'S PAIN MANAGEMENT

  • After an oral surgery, the next concern of the oral surgeon is to provide the most effective pain relief. But the prescription takes place right after the surgery while the patient is still numb after the anesthesia treatment. And therefore, the level of pain is not gauged fully.
  • To treat the pain, 22% of oral surgeons still prescribe more than 20 opioid tablets, and more than 30 tablets was prescribed by 11%.
  • Some oral surgeons declare that their issuance of opioid prescription has become a tradition because it has been considered effective and their "awareness of its negative impact is minimal".
  • Based on a survey by an oral surgeons' association, 99% of their members still prescribe opioids, but they are now usually prescribing it along with NSAIDs.

EFFECTS OF OPIOID-BASED MEDICINE DEPENDENCY
  • According to the National Institutes of Health, about 115 Americans die each day due to opioid overdose.
  • In a survey to more than 1 million opioid patients undergoing surgery, the long duration of taking opioid is considered to be the strongest predictor of misuse and risk for individuals aged 15-24.
  • Every day that a patient remain dependent to opioid pills, it increases the chances of addiction.

PATIENT'S ROLE IN PAIN MANAGEMENT (IN ORAL SURGEON'S POINT OF VIEW)

  • In a minor oral surgery, techniques to eliminate pain have progressed, but the application of the local anesthesia itself is very painful, giving the perception to most patients that dental treatment is invasive and painful.
  • Aside from pain management, anxiety control plays a big role on how patients react to the whole process of surgery.
  • Among patients, about 20% either do not take pain relievers or requires a more intense relief of their pain after an oral surgery.
  • Angi Rake, an oral surgeon who supervises oral surgery clinics and works on reducing the prescription of opioids among other surgeons, stated that in some cases, the patients themselves (or their parents) "expect" that the oral surgeon will prescribe opioid to eliminate the pain and sometimes asks why they have prescribed less than usual.

ORAL SURGEONS' CONFIDENCE LEVEL ON HOW PAIN WORKS AND ITS TREATMENT

  • The current scare of opioid addiction and possible death has led some legislature and state to put legal limits when it comes to prescription.
  • The ADA now suggests oral surgeons and dentists to consider NSAIDs prescription as their first-line treatment for pain.
  • Among the oral surgeons surveyed, 50% of the respondents said they have decreased the prescription of opioid to their patients.
  • The new discovery released by ADA on better pain management after oral surgery enables oral surgeons and dentists to address the patient's level of pain in A safer way.
Part
06
of nine
Part
06

Oral Surgeon Persona: Procedure Follow Up Appointments (Patient POV)

USEFUL FINDINGS

VARIANCE IN POST-SURGERY SATISFACTION LEVELS AMONG ORAL SURGERY PATIENTS

MORE PATIENTS CHOOSE OPIOID FOR ACUTE PAIN MANAGEMENT

  • An opioid is often prescribed when the pain is acute.
  • In terms of patients choosing filling out their prescriptions for an opioid for pain management after the surgical procedure relating to wisdom teeth removal, it was found that 56,686 wisdom tooth patients filled their opioid prescriptions between 2009 and 2015.
  • While, a far less number, i.e., 14,256 wisdom tooth patients didn’t fill an opioid prescription.
  • Therefore, it can be inferred that people going through acute pain after wisdom teeth removal is four times higher (56,686 Vs. 14,256) than the ones not going through it.
  • As per a report published in NCBI PubMed, pain following oral surgery was highly prevalent in the United States, which made active management of post-surgical pain, a primary concern for clinicians.

SATISFACTION PERCENTAGE AMONG PATIENTS WHO HAVE UNDERGONE OVERALL DENTAL CARE

  • In terms of Dental Care as a whole, almost one-fourth of patients treated were dissatisfied with a certain aspect of their dental care experience.
  • It was also found that in the realm of overall dental care treatment satisfaction of patients who received invasive treatment did not differ much from those who received non-invasive treatment.

Research Strategy

To find the required information, we looked into various reports of surgeons and different academic and medical journals. We also looked into medical hospital records and medical news sources.

Reports from Associations of Surgeons

We started our search by looking into the websites of Oral Surgeons, Dental Surgeons in the US, both nationally and state-wise. The sources we looked into included sites such as the American Association of Oral and Maxillofacial Surgeons, Ohio Society of Oral and Maxillofacial Surgeons, The American Society of Maxillofacial Surgeons American College of Oral and Maxillofacial Surgeons and American Society of Dental Surgeons, and American Dental Association. Our objective behind looking into these sources was to find whether these associations were recording insights availed for patients to improve their interventions or pain management techniques. However, no information could be found as most of the reports, articles, and whitepapers dealt mostly with improved treatment procedures and the advent of new technologies.

Academic and Medical Databases

We then looked for academic study reports available in sources such as Academia Researchgate and Google Scholar. We also looked into specific medical or surgery related databases, which included PubMed from NCBI, The Journal of the American Medical Association or JAMA, Journal of Oral and Maxillofacial Surgery (JOMS), and others. Although a few reports in these sources dealt with the aspect of pain management meant for patients, the insights were not representative or inclusive of a set of patients opinion. The new ways of pain management were mostly provided in the form of details relating to new surgical procedures whose effectiveness or satisfying capability was not yet tested among patients; neither were their qualitative opinions mentioned.

Providers of Surgeries i.e, hospitals

We also looked into the websites of some of the largest hospital chains in the United States such as Hospital Corporation of America; Community Health Systems, Ascension Health, Catholic Health Initiatives, Trinity, Tenet Healthcare, and others. We also looked into some specific facilities such as the Department of Plastic and Oral Surgery at Boston Children Hospital, Department of Oral and Maxillofacial Surgery — Mass General Hospital. Our aim was to find any report/study/survey that these organizations may have done on surgeries conducted at their facilities through patient satisfaction surveys. Although many of the facilities had the provision of post-surgery data collection online in their websites, none of these data were combined/compiled and put out in the public domain presumably owing to the safe and confidential upkeeping of patient data.

Medical news sources

We finally looked into the different medical news in the US, including sites such as medicalnewstoday.com, news-medical.net, WebMD, Healthline, Medscape, and others. Our aim was to find whether any of these sources did any third-party research on how satisfied patients were with their surgeons/surgical facilities. Although there was minimal information available relating to individual cases where surgeries went wrong for patients, there was no information relating to the post-surgery satisfaction of the patients.
Part
07
of nine
Part
07

Oral Surgeon Persona: Procedure Follow Up Appointments (Provider POV)

Each year in the US there are 3.5 million molar extractions that require pain management, of which, oral surgeons often prescribe opioid to ensure their patient experiences as little pain as possible. This happens largely because patients who do not receive opioid painkillers feel neglected and disgruntled. However, specific information about whether oral surgeons generally believe their patients are satisfied with the level of pain management / prevention they provide was not available.


KEY INSIGHTS

  • A third molar extraction is the dental procedure that requires the most pain management.
  • There are 3.5 million third molar extractions in the US annually.
  • The pain medications most commonly prescribed following a third molar extraction are hydrocodone, oxycodone, Vicodin®, or a combination of APAP and hydrocodone.
  • Two of 384 (64%) respondents in a survey of 600 oral and maxillofacial surgeons reported that they did not prescribe a narcotic after the removal of an impacted third molar.
  • "The most frequently prescribed narcotic was hydrocodone 5 mg, followed by oxycodone and codeine. Most the practitioners prescribed 20 tablets, however, 22% prescribed more, with 40 practitioners prescribing more than 30 tablets."
  • Opioid pain medications are usually prescribed for 3-10 days following dental surgeries.
  • There are no references or research on the effectiveness of hydrocodone as a pain medication.
  • To treat pain following the extraction of wisdom teeth, oral surgeons usually prescribe 325 mg of acetaminophen taken with 200 mg of Ibuprofen.
  • Patients typically receive opioid pain medication following dental surgery. However, by talking to their surgeon, they may reach a mutual decision to try non-opioid pain management.
  • Because doctors do not know how much pain a patient will experience, they will often provide a prescription for an opioid analgesic sufficient to manage the worst (most painful) recovery.
  • After a surgical procedure, patients expect their oral surgeon to manage any pain experienced during their recovery, causing their oral surgeon to feel obligated to prescribe opioids.
  • Some patients feel dissatisfied with a non-opioid option and may consider a prescription of non-opioid pain management as uncaring or unsympathetic.
  • "Effective pain management is, after all, the Holy Grail for achieving patient satisfaction."
  • Prescribing non-opioid pain managements can have significant consequences such as poor ratings on social media from upset patients who feel neglected.
  • The American Association of Oral and Maxillofacial Surgeons (AAOMS) published a white paper with recommendations on their postoperative pain management methods.
  • According to a Nielsen Harris Poll, 7 out of 10 US respondents opt for a non-opioid medication to treat post-surgical pain from third molar (wisdom tooth) extraction if given the choice.


RESEARCH STRATEGY

We began our research by looking for precompiled information in credible sources regarding the pain management methods provided by oral surgeons in the US. The goal was to find quantitative and qualitative data regarding the patients' satisfaction on post-oral surgeries and patient management administered by their oral surgeons. We looked on industry-related websites, scholarly journals and reports, and education websites for this information. Unfortunately, we did not find direct data, but we were able to find common methods/medicines administered to patients after dental surgery. We found that the most common dental procedure that requires pain management is a third molar extraction. Additionally, we found that the medicine most commonly used to combat pain from this procedure includes hydrocodone, and oxycodone, Vicodin®, or a combination of APAP and hydrocodone.

As a second method, we tried to triangulate an answer using data points from surveys and interviews on the effectiveness of post-oral-surgery pain management procedures. We looked on websites such as Researchgate, Semanticscholar, and other scholarly publications. While many surveys have been conducted on pain management, they do not specifically show how patients' feedback impacts the way oral surgeons administer pain relief. Furthermore, these reports did not offer any insights into a surgeons' perspective on the gaps present in oral surgery pain management. Therefore, we could not accumulate enough hard data to calculate a triangulation.

As a final approach, we referenced locked and paywalled sources. We looked at the previews, which contained information about the satisfaction from dental clinics/hospitals regarding pain management. We found that dental clinics/hospitals conduct patient satisfaction surveys, so we tried to look for patient satisfaction surveys to see if they have data on pain control procedure satisfaction. We located key players in the oral surgery industry to see if they provided any of the results of their surveys. We hoped to triangulate the information by looking at the pain control method done in each clinic. Unfortunately, of the reports we found, the clinics did not specify information about the pain control administered or patient/doctor satisfaction.

We assume that the unavailability of this data is due to the limited research studies conducted regarding this topic. Also, pain management is varying depending on the patient and on the perspective of oral surgeons, which makes it difficult to assess feedback. Because patient information is confidential, it may be difficult for research to be conducted in this area.
Part
08
of nine
Part
08

Oral Surgeon Persona: Pain Perceptions

Many patients experience pain anxiety before oral surgery. Oral surgeons suggest patients discuss their fear of pain with their respective surgeons and discuss anesthesia options so surgeons can alter the mode of ingesting anesthesia to methods such as laughing gas, oral sedation, and IV sedation to give a pain-free surgical experience. Below is an overview of the findings.

Patient’s Pain Perception Before Surgery

  • As per the American Society of Anesthesiologists (ASA), 75% of patients have some concerns on anesthesia before oral surgery and 37% are fearful and have an anxiety of general anesthesia in oral surgery.
  • As per the Oral & Maxillofacial Surgery of Utah, many patients experience potential pain anxiety before oral surgery.

Prevention Techniques

  • Oral surgeons suggest patients discuss their fear of pain with their respective surgeons and ask for anesthesia options where surgeons alter the mode of ingesting anesthesia such as laughing gas, oral sedation, and IV sedation to give the patient a pain-free surgical experience.
  • Oral surgeons suggest patients focus on breathing and listening to music during the surgery. They also suggest patients talk to the oral surgery team before the surgery to relieve their pain anxiety concerning oral surgery.

Influences on Oral Surgeon's Treatments During Surgery

  • Oral surgeons often modify the treatment plan to calm down patients with pain anxiety.
  • Oral surgeons allow patients to choose the type of sedation during surgery. Some patients want to be unconsciousness during the surgery and for such patients, surgeons use IV sedation.
  • For patients who are moderately worried about pain during oral surgery, a local anesthetic is given as an oral pill which numbs the oral cavity but enables the patient to remain conscious.

Patient’s Pain Perceptions After Surgery

  • According to oral surgery associates, "many patients feel that they do not need the stronger medication for pain relief." Side effects patients experience from the medication include nausea, drowsiness, and vomiting.

Prevention Techniques

  • For the first level of pain management, oral surgeons suggest patients take drugs such as ibuprofen and Acetaminophen for recovery.
  • Oral surgeons suggest discontinuing the medication if the patient gets the hives or a rash and also suggest immediate consultation.

RESEARCH STRATEGY

Initially, we started looking for information on patient perceptions of pain before and after oral surgery and how this influences what the surgeon may do during, before and after surgery in various medical journals, medical research surveys (such as Remedy Publications, WebMed Central, Pocket Dentistry, NJCP Online, Researchgate, Cochrane Library, JNSBM, and others). We were able to locate a lot of information on patient perceptions of pain in general. This information, however, was not specific to oral surgery or specific to the U.S. or not specific to pain.

Next, we searched for the information in Oral & Maxillofacial Surgeons associations and hospital websites (such as AZOMS, Oral and Facial Surgery, Mountain Oral Surgery, Oral Surgery of Utah, and others) and could locate subjective information on the need for stronger medication, the side effects of medication, and drugs recommended for pain management. Similarly, we were able to locate subjective insights on the pain perceptions patients have before surgery and advice given by oral surgeons to patients

As Oral & Maxillofacial Surgeons associations and hospital websites contained only subjective insights on patient pain perceptions, we expanded the scope of search beyond the Wonder time limit and searched for statistics on oral surgery in dental journals (such as Scient Online, NCBI, MDPI, JADA, JS Scholar Online, etc.). We were able to locate only one relevant study from 2014 from the American Society of Anesthesiologists (ASA).


Part
09
of nine
Part
09

Oral Surgeon Persona: Pain and Caregivers

Oral surgeons work with patient caregivers/parents of minor patients when it comes to pain management to decide on the opioid pain treatment consent and drug intake to avoid abuse of the guidelines on the proper disposal of leftover pills.

ROLE OF A CAREGIVER

  • Opioid Drug Abuse/Intake: Opioid prescription is a very common practice by oral surgeons and other dental healthcare providers to curtail the pain patients feel after severe dental procedures or surgeries. Unmonitored dosage of opioid can be fatal, especially in adolescent and minor patients. Hence, parents/caretakers play an important role to ensure the safe and competent opioid intake during pain management for the patients and follow the directed guidelines of opioid safety principles for patients and caregivers by American Academy of Pain Medicine to curtail drug abuse.
  • Consent Form: In multiple states of the United States such as Pennsylvania, Ohio, and others, the minor patients' caregiver/parents are required to provide their consent by signing a form for prescribing opioid prescriptions to the patients in non-emergency circumstances for medical treatment and pain management including dentistry.
  • Patient Care: Through studies, it was found that the role of a caregiver/parents whose children were prescribed opioids after inpatient surgery need to ensure proper disposal of the leftover medication to avoid any risk of drug abuse due to diverted pills.

ORAL SURGEONS

Conversation with a Caregiver

  • Since opioid prescription is a common practice by dentists for pain management in the treatment of oral pain, the caregiver/parent of adolescent/minor patients (1-21 years) share the past medical history and are required to share their consent by signing a form to acknowledge the risk associated with opioid intake.
  • For proper patient care after inpatient surgery, the dentist/surgeon shares proper guidelines to the caregiver/parent of the patient, especially, in the case of minor patients on the opioid intake and proper disposal of leftover pills.
  • Patients with Alzheimer’s disease (AD) are heavily dependent on caregivers with low oral health literacy and at times are at greatest risk, so caregivers need to be included in all patient education efforts and pain management treatment.

Surgeons Decisions Around Pain Management/Prevention

  • Wisdom tooth extraction is often the first-time patients are exposed to opioids. According to a survey report by the American Society of Anesthesiologists, parents/caregivers of minor patients have conflicting thoughts about using opioids to treat their child’s pain.
  • The survey report states that "more than half of parents said they are concerned their child may be at risk for opioid addiction" although they believe that opioids are more effective at managing their child’s pain after surgery.
  • It is possible that the patients pain treatment course could be altered, influencing the oral surgeon after the pre-surgery discussion with the parent/caregiver on the general thoughts on pain management and pain medications, and details on patient’s pain tolerance, personal history of substance use disorder (SUD) or SUD within the family, and any particular concerns about pain medications/opioids

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  • The national survey by American Society of Anesthesiologists highlights that 59% of parents whose children were prescribed opioids asked their doctor about pain management alternatives. 88% of parents recognized non-opioid over-the-counter medications such as acetaminophen to be effective in treating pain.
  • The survey also revealed that only a few parents are aware of the range of options available under the non-opioid pain treatment, pain therapy, and other alternative medications for children.

RESEARCH STRATEGY

We were able to garner relevant and recent information from many credible sources such as Pubmed, Crossref, NCBI, and other similar domains. We came across certain important data points on DecisionInDentistry, however, the information was published in the year 2016. Since we were unable to locate similar data published in recent years, we included the older source in this research.
Sources
Sources

From Part 01
Quotes
  • "AAOMS members comply with rigorous continuing education requirements and submit to periodic office evaluations, assuring the public that office procedures and personnel meet stringent national standards."
Quotes
  • "Live webinars provide a multitude of benefits, including the opportunity to ask questions and receive answers – sometimes on-the-spot – from expert speakers. Other benefits include being able to follow up on questions from audience members and learn from other attendees to enhance understanding of the subject."
Quotes
  • "The journal also includes specifics on new instruments and diagnostic equipment and modern therapeutic drugs and devices. J"
Quotes
  • "We develop educational activities that address the learning wants and needs of our members and other surgeons and seek to enhance surgical excellence by identifying and closing existing gaps in knowledge."
From Part 02
Quotes
  • "As per Technavio, the growing adoption of 3D printing technology by dental professionals will have a positive impact on the market and contribute to its growth significantly over the forecast period. "
  • "The field of 3D printing is a rapidly advancing technology, which is being adopted by dental professionals worldwide for various clinical and research purposes. 3D printing technologies are increasingly being used to develop surgical instrumentation and patient-matched (or patient-specific) devices through medical imaging"
  • "Apart from 3D printing technology, new product launches is another aspect that is boosting the market growth. Several vendors are seen increasing their R&D investments to improve their existing products and developing innovative products. For instance, vendors have developed a dental diode laser system. "
  • "The North American region led the market in 2018, followed by Europe, APAC, and ROW, respectively"
Quotes
  • "But even though their specialty is specific, the technology used to treat and operate on the face, mouth and jaw is constantly evolving"
  • "You have to have a commitment to lifelong learning," says Louis Rafetto, president-elect of the American Association of Maxillofacial Surgeons, chairman of the oral and maxillofacial residency program at Christiana Care Health Systems and a private practitioner in Wilmington, Delaware. In general, Rafetto says, "the surgeries will stay the same, but the way we do them will change."
Quotes
  • "Technological advances were more incremental and less impactful on other branches of medicine. Nevertheless, these advances helped to make dentistry a highly respected and sought-after profession."
  • "Digital dentistry refers to a wide scope of technologies and devices — introduced in the past several decades — that incorporate digital or computer-controlled components in contrast to mechanical or electrical devices alone. "
  • "One of the most recent technological advances is Invisalign®, a system that creates a series of computer-generated clear plastic orthodontic realigners to correct slight malocclusions"
  • "More recently, a new technology developed at the NYU College of Dentistry has been shown to significantly decrease the amount of time required for a patient to wear braces."
  • "These are but a few examples in the long and distinguished history of discoveries, technological innovations, and transformations in the stature of the profession that have made dentistry a progressive force for improved public health. "
  • " Today, dental treatment for caries and periodontal disease is moving into a period of fewer invasive and more preventive interventions."
Quotes
  • "Millennial Oral surgeons are classified as “digitally native,” or people born during or after the rise of modern technology. Millennial surgeons are protective of their leisure time, and believe strongly in using technology to reduce their overall workload."
  • "Millennial surgeons believe in the value of innovation, and are more likely to adapt new techniques and technology"
  • "Bridging the generational gap to build a cohesive, digitally transformed oral surgery practice requires a strategy that reflects the vision and capabilities of the entire team."
  • "Regardless of their technology background, all team members, whether digital native or immigrant, must be treated as valuable assets, and incorporated into the process of digitization."
Quotes
  • "Education also influences dental practice and dental schools are reconfiguring current curricula to lead an evidence-based program of education utilizing digital technology in dentistry. "
  • "A 2015 survey of faculty members by the American College of Prosthodontists revealed that dental educators currently report 92% use 3-D radiography, 69% use intraoral scanners, and 50% use in office mills and this contrasts to 56%, 32%, and 17% of private practice prosthodontists, respectively."
  • "The familiarity of prosthodontist faculty with digital technology is a key feature that may positively influence the adoption of digital technology in the broader community of interest. The traditional of barriers within dental schools are rapidly eroding."
  • "At the clinical level, the three most widely adopted digital technologies were digital radiography (91%) and cone beam CT (85%), CAD/CAM indirect restorations (58%), and virtual surgical guides and implant placement (30%)"
  • " Focusing only on the prosthodontic discipline, educators are engaging in emerging digital technologies. A recent survey of US dental school deans conducted by Brownstein et al (2015) reported that greater penetration of digital technology occurred in preclinical didactic courses and the lowest was in preclinical laboratories"
Quotes
  • "Digital X-rays not only save time but also contain less radiation compared to traditional X-Rays technology. Besides, the new X-Ray technology also helps dentists repair cavities without drilling, a process a lot of people fear. Digital X-rays allows dentists to zoom in on a live image and assess the situation better. This puts in a lot of confidence in the patient as well. Today most dental surgeons in Miami are equipped with this technology. "
From Part 04
Quotes
  • "Some of the most effective analgesics may not be included on formularies because of high costs, a requirement for preauthorization, or high copayments because of third-tier status."
Quotes
  • " It is important, however, to consider lowering costs without sacrificing patient safety. "
Quotes
  • "The healthcare industry is under major stress from steady declines in all sources of revenue."
Quotes
  • "The studies outlined above suggest that, even in the setting of acute traumatic injury, there may be significant disparities in outcomes and the provision of emergent health care services based on patient insurance status"
From Part 05
Quotes
  • "Having your wisdom teeth removed is one of the most common mouth surgeries in the United States. It represents 95% of all tooth removals among 16 to 21 year olds with insurance."
  • "Some dentists recommend opioid-based medicines like Vicodin or Tylenol with Codeine for their patients. Generally, these were thought to be most effective pain relievers after dental surgery. This method became standard in the 1970s, almost 10 years before “non-steroidal anti-inflammatory drugs,” or NSAIDs like Tylenol and Advil, were even known to relieve pain."
  • "Clinical studies have found that when you take acetaminophen and ibuprofen together, they are more effective for pain relief after oral surgery than opioid-based-pain medications."
Quotes
  • "Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with acetaminophen are better at easing dental pain, according to new research conducted with the School of Dental Medicine at Case Western Reserve University. The study examining relief of acute pain in dentistry -- recently featured on the cover of The Journal of the American Dental Association -- evaluated the safety and efficacy of dozens of pain-relief options."
  • "Each day, more than 115 Americans die as a result of an opioid overdose, according to the National Institutes of Health."
  • "The research found that, for adults, a combination of 400 milligrams of ibuprofen and 1,000 milligrams of acetaminophen was superior to any opioid-containing medications studied."
Quotes
  • "Anxiety control remains an important concern in dental practice, particularly with regard to minor oral surgeries. Although pain elimination techniques using local anesthesia have progressed, injection of the local anesthetic itself is so painful that the dental treatment is perceived as painful and invasive by most patients. Anxiety and dental fear continue to pose significant problems to both patients and dentists. Pain and anxiety control is fundamental to the practice of dentistry."
Quotes
  • "In a survey of 1,015,116 opioid naïve patients undergoing surgery, total duration of opioid use was the strongest predictor of misuse and the greatest risk for individuals in the 15-24 age group. Young people aged 15-24 often get their first exposure to opioids with dental surgery. "
  • "In a survey of randomly selected oral surgeons conducted by Dr. Abubaker and colleagues, the average number of opioid tablets prescribed was 20, with 22% prescribing more than 20 tablets, and 11% prescribing more than 30 tablets. "
  • "These risk factors, combined with the current epidemic, have led many oral surgeons to believe that the old standards of depending on opioids as a first-line treatment should be a thing of the past. The number of opioid prescriptions written should decrease moving forward, as dental pain can often be managed without opioids."
  • "“Dentists play an important role in the opioid epidemic through overprescribing – usually with good intentions – but we need to accept accountability for our role in the problem,” stated Dr. Abubaker. “When managing dental pain, we must strike a balance between compassionate patient care by managing their pain and not suffering, and patient safety. It is a balance that is achievable.”"
Quotes
  • "What is the best painkiller for tooth extraction? A:Many people find 400 milligrams of ibuprofen to be effective at managing pain after a simple extraction. I’d recommend taking this dosage three to four times a day, as it can also reduce your swelling. If your dentist prescribed an opioid pain reliever, try to limit your consumption. Each day you remain on opioid pills drastically increases your chances of addiction."
Quotes
  • "But every year, oral surgeons remove the wisdom teeth of about three million people. The majority are under 25. And virtually all leave surgery with a prescription for opioids."
  • "The oral surgeons association survey found that 99 percent of members prescribed opioids — usually along with NSAIDs"
  • "Other doctors prescribe opioids because patients — or patients’ parents — expect them to."
  • ""The problem is that “best professional judgment” too often translates into “I’ve always done it this way.” “Some argue: ‘I’ve been doing this for many years — what I’ve done prescribing opioids has been effective and my awareness of negative impact is minimal,’ ” Tu said. “But there are those who recognize this is an opportunity to change our prescriber behavior for patients. One of the basic tenets of who we are as health care providers is to address pain and suffering. And balanced against that is our responsibility to do no harm.”"
  • "The current epidemic of opioid death and addiction has led to some action. Some state legislatures have put legal limits on prescriptions. The American Dental Association now says that dentists “should consider” NSAID as their first-line pain treatment."
  • "In the oral surgeons’ survey, half the respondents said they had decreased their prescriptions of narcotics. The plurality of oral surgeons who responded to the survey said they prescribed 17 to 23 opioids — four to six days’ worth."
From Part 06
Quotes
  • "Acetaminophen and ibuprofen, when combined, offer an alternative to opioid-based pain medications following oral surgery. This discovery allows dentists and oral surgeons to address their patient’s pain level in new, safer ways."
  • "For some, opioid-based pain relievers may be the only option. Approximately 20% of patients either cannot take pain relievers like Tylenol or Advil, or they require more intense pain relief after oral surgery. "
  • "In addition to prescription medication, patients should always be aware of post-operative instructions. Home care instructions must be followed to experience the best outcome. Lifestyle habits, such as smoking or alcohol consumption may increase the risk of infection and pain after surgery. "
Quotes
  • "Unfortunately, there is an increase in the unjustified use of opioid analgesic drugs in dentistry, especially in oral surgery, prescribed for pain management after tooth extraction or third molar surgery. In 2015 in the United States of America (USA), there were more than 52 404 deaths due to drug overdose, out of which 63.1% were from opiate and opioid drugs"
  • "In scientific and medical associations in the USA there are more and more discussions on the topic of opioid epidemic and its control. It is estimated that patients’ expectations to receive opioid analgesic after dental treatment and dentists’ fear of an unsatisfied patient are the main causes for opioid analgesic prescription "
  • "It has been estimated that almost two-thirds of 14 to 17-year-olds receive opioid prescriptions from dentists following the third molar extraction "
Quotes
  • "In all, 1.3 percent of 56,686 wisdom tooth patients who filled their opioid prescriptions between 2009 and 2015 went on to persistent opioid use — which is defined as two or more prescriptions filled in the next year written by any provider for any reason."
  • "Of the 14,256 wisdom tooth patients who didn’t fill an opioid prescription, only 0.5 percent went on to become persistent users."
  • "If pain is acute, they should prescribe fewer pills than the seven-day opioid supply recently recommended by the American Dental Association for any acute dental pain."
  • "Some uncertainties remain. The data show opioid prescriptions filled, not actual use of opioid pills by patients. Leftover opioids pose a risk of their own, because they can be misused by the individual who received the prescription, or by a member of their household or a visitor."
Quotes
  • "In light of the high prevalence and burdensome clinical impact of pain following oral surgery, as well as the presurgical anxiety that affects many patients, effective management of postsurgical pain is a primary consideration for clinicians."
Quotes
  • "About one-fourth of patients treated for non-cavitated early caries were dissatisfied with at least some aspect of their dental care experience."
  • "Satisfaction of patients who received invasive treatment did not differ from those who received non-invasive treatment. "
  • "A small percentage of patients declined the dentist’s recommendation for non-invasive treatment and chose invasive dental treatment instead."
From Part 07
Quotes
  • "The most common dental procedure that requires pain management is third molar extraction, that has an estimated annual incidence of 3.5 million. Past literature has shown that dentists prescribe mainly hydrocodone and oxycodone, with Vicodin®, a fixed-dose combination of APAP and hydrocodone, being the most commonly prescribed pain medication in the U.S. after third molar extraction. These narcotic combinations are currently the most abused prescription drugs yet the most prescribed pain relieving analgesics."
  • "An 8-question survey administered to 600 oral and maxillofacial surgeons showed that only 2 of the 384 (64%) respondents reported that they did not prescribe a narcotic after the surgical removal of an impacted third molar. The most frequently prescribed narcotic was hydrocodone 5 mg, followed by oxycodone and codeine. Most the practitioners prescribed 20 tablets, however, 22% prescribed more, with 40 practitioners prescribing more than 30 tablets."
Quotes
  • "According to a new national survey of over 1,500 oral surgery patients or their parents, more than seven in 10 respondents indicated they would opt for a non-opioid medication to treat postsurgical pain from third molar (wisdom tooth) extraction if given the choice. Approximately 80 percent indicated they would do so even if the medication was associated with additional cost. Despite the desire for an alternative, 70 percent of respondents reported an opioid was prescribed post-extraction, illustrating a clear divide between patient preference and the current standard of care."
  • "The research, which was conducted by Nielsen’s Harris Poll Online using a nationwide electronic survey, highlights an opportunity to bridge the gap in surgeon/patient communication. At least 90 percent of patients and parents indicated wanting the opportunity to discuss a personal pain management plan with their surgeon in advance of their procedure, and many (up to 71 percent) reported feeling concerned about the potential for opioid-related adverse effects. Despite this, only approximately 40 percent actually discussed these concerns with their surgeon."
Quotes
  • "It is estimated that almost two-thirds of 14- to 17-year-olds receive opioid prescriptions from dentists following third-molar extractions.4 It is common for clinicians to prescribe three to 10 days of postoperative opioid pain medications following dental surgeries. Surprisingly, there are no references or research on the effectiveness of hydrocodone as a pain medication"
  • "A review article by Moore and Hersh5 addressing the treatment of dental pain following wisdom tooth extraction concluded that 325 mg of acetaminophen taken with 200 mg of ibuprofen provides better pain relief than any oral opioids combination. They concluded, “The results of the quantitative systematic reviews indicated that the ibuprofen-acetaminophen combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations.”"
  • "Although patients may assume they will receive an opioid pain medication following dental surgery, a simple conversation may lead to a mutual decision to try a nonopioid pain management regimen first."
Quotes
  • "It is the position of AAOMS that the practitioner-patient relationship must be upheld, allowing for practitioner judgment in the management of a patient’s pain – including drug types, dosages and treatment durations. Pain management decisions should be individualized and only determined after a careful assessment of the level of risk to – and condition of – the patient. "
Quotes
  • "After completing any surgical procedure, patients expect and deserve our best efforts to manage any pain experienced during their days of recovery at home. Because a patient expects to receive the most effective of pain relievers, dental and medical care practitioners often feel obligated to prescribe opioid combinations such as Vicodin or Percocet. "
  • "If we prescribe or recommend a nonopioid, some patients may be dissatisfied and may consider the provider uncaring or unsympathetic. Effective pain management is, after all, the Holy Grail for achieving patient satisfaction."
  • "Not providing an opioid prescription also can have significant consequences for today’s medical and dental practice models. Formal provider reviews conducted by corporate and hospital administrators can include poor ratings from patients who are disgruntled when they have not received their preferred opioid analgesic, even when it is not indicated. Because many dental and medical practices provide care in private settings, practitioners risk receiving critical postings on social media sites as well. "
  • " We prescribe opioid analgesics to manage patients’ potentially severe postoperative pain, and at times we feel influenced to provide opioid analgesics to ensure patient satisfaction."
Quotes
  • "From the above data, the authors concluded that there were no significant differences in recorded pain levels between the two groups during the first 48 hours after surgery. Also, the two groups did not differ in their global ratings of postoperative pain."
  • "During the follow-up period, 12 of the 67 control subjects and four of the 64 intervention subjects claimed that their prescribed treatment schedule did not provide sufficient pain relief for the immediate 48-hour period after third molar surgery."
  • "Acetaminophen and codeine combination is a DEA schedule III drug in the U.S. and could become more widely prescribed after oral surgery relative to hydrocodone or oxycodone in combination with acetaminophen, which are both schedule II drugs. Schedule III drugs can be telephoned into the pharmacy and refilled without a new prescription, whereas schedule II agents cannot be called in or refilled without a new prescription. However, the results of this study call into question the efficacy of codeine, since its addition to a regimen of acetaminophen and ibuprofen does not appear to improve analgesia after oral surgery."
From Part 08
Quotes
  • "For many patients, surgery anxiety relates to the potential pain and trauma they may believe accompany the procedure. A discussion about anesthesia can reduce these fears, as you may even have the option to choose your preferred method. Oral sedation, laughing gas and IV sedation are among the many anesthesia options that can provide you with a relaxing, pain-free surgical experience."
  • "Some patients want to know everything about their upcoming procedure, while others simply need to know the basics to feel more comfortable. Make a point to learn enough about your upcoming surgery to help alleviate your concerns."
Quotes
  • "Although more than 75% of the patients in the ASA study expressed having some concerns about anesthesia for general surgery,1 only 37% of the patients in this study had fear and anxiety about having general anesthesia for an oral surgery procedure, and this was generally slight or mild"
  • "Fifty-nine of the 94 patients (63%) stated that they were unafraid of undergoing general anesthesia, whereas 35 (37%) stated that they had fear/anxiety"
Quotes
  • " However, many patients find they do not require the stronger prescription medication for pain relief. Additionally, patients can experience significant side effects from these medications that include nausea, vomiting, drowsiness, dizziness, and constipation. Also, you should not drive and avoid consuming alcohol while taking narcotic pain medications."
  • "The following is a regimen that minimizes or eliminates the need for the narcotic pain medications. We recommend that you follow the first level and move to the second level of pain management if needed for more severe pain relief."
Quotes
  • "Rest assured that all of our procedures are safe and effective. But in many cases, we may be able to modify your treatment plan to help you feel more at ease, including giving you options regarding your method of anesthesia."
  • "Oral sedation, laughing gas and IV sedation are among the many anesthesia options available today. We will help you choose the one that makes you the most comfortable."
  • "Research strongly suggests that listening to music can help alleviate surgery anxiety. Though science can’t tell us exactly why music helps, experts believe that it reduces stress by providing a pleasant distraction. Some studies recommend listening specifically to classical music, but most research shows that you can benefit from listening to any type of music you like."
Quotes
  • "Take your medications as directed on the package. If you develop hives or a rash, discontinue all medications and contact our office. Do not drive or operate mechanical equipment after taking prescription pain medication."
Quotes
  • "Some patients prefer to be asleep and unaware during oral surgery. In addition, some complex or extensive surgical procedures — especially those that take longer to complete — may require stronger anesthetic methods."
  • "Intravenous (IV) sedation is a common choice for these circumstances. IV sedation is administered directly into the bloodstream and allows the patient to remain unaware and pain-free throughout surgery."
  • "For that reason, our oral surgeons will, in most cases, allow you to choose the method of sedation you prefer for your oral or maxillofacial surgery. You may opt for a milder method if you just have a bit of nervousness. Or, if your anxiety is more severe, you may prefer IV sedation."