By: Dr. Wanda Nazario MCS Dental Administration Services Medical Director August 2024
If we look at healthcare from a holistic perspective, it’s essential to consider oral health, given its relationship with general health and some systemic diseases. From education to minimizing and avoiding complications associated with oral disease, primary care physicians and dentists can become allies in supporting optimal oral patient care. And while patients often visit their primary care physicians first when they experience dental pain or suffer from dental-maxillofacial trauma, this highlights the vital importance of primary physicians having the tools to effectively assess oral discomfort and be aware of the effective and safe treatments they can administer in the primary care setting, to manage the patient’s symptoms before they visit their dentist for an assessment.
Regarding the management of dental pain, the American Dental Association (ADA) specifies that opioid drugs should not be the first therapy recommendation to manage this type of pain, as it is mostly inflammatory in origin and usually caused by pulpitis or abscesses. Drugs commonly used for pain, such as nonsteroidal anti-inflammatory drugs, acetaminophen, or a combination of both have been shown to be more effective. In January 2022, the CDC published that, when visiting the emergency room for a dental condition, 60% of young people are given a prescription for opioids. This is concerning, as it exposes patients to these drugs at a very young age, along with the risks that accompany their use and abuse.
Therefore, knowing the specificity of the patient’s discomfort is essential for primary management and treatment. For this, the following questions should be asked:
Where do you feel the pain?
When did it start?
Can you describe the pain?
Has the pain spread to other areas?
Are there other health problems associated with the pain?
Does the pain follow a pattern? How long does it last?
Is there anything that makes the pain worse or better?
How does the pain affect you?
If the pain is the result of an infection, the ADA has created care guidelines to help determine when an antibiotic is indicated, what type of antibiotic to prescribe, and the recommended follow-up, if necessary. According to the guidelines, patients should receive antibiotics when the infection becomes systemic. The first treatment option should be amoxicillin, with other options provided for patients who are allergic to it. An important factor to also consider when choosing a treatment is the dentist’s availability for an appointment. If the infection includes a fever, facial edema or lockjaw, the patient should go to the emergency room.
During the medical visit, it’s important to make it clear to patients that antibiotics or painkillers only treat the symptoms and do not control dental infections. Therefore, they will need to visit their dentist to resolve the cause of the problem. Feeling relief from their symptoms, many patients think their condition has been resolved and don’t follow up. It’s common to hear patients who avoid going to the dentist say the visit causes them anxiety, they fear dental procedures, or don’t have dental coverage in their insurance plan. Any reason that causes patients to delay their visit to the dentist will lead to complications and more complex and expensive treatments. Sometimes, a patient’s situation may become even more complicated to the point of hospitalization.
A good practice that can optimize the service provided by the primary care physician is to connect with dentists who offer services near the physician’s medical office. This strategy facilitates the continuity of treatment and teamwork, promotes the proper use of the healthcare system, and ensures patient health. In addition, integrating oral health services into the care provided to patients with chronic conditions can have a positive impact on their health status. We want complete health, and this integration of services is an important step towards achieving that goal.
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