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When a patient has to have oral surgery, one of the most common questions we get is “Is this going to hurt?.” Unfortunately, as with any surgical procedure, oral surgery will cause some degree of post-operative discomfort.  At Loudoun Oral and Maxillofacial Surgery, we are very aware of our patients’ fears and customize our pain management approach for each patient.

The Problem With Opioids

Opioid analgesics like Vicodin®, Percocet®, and Oxycontin® are the most frequently abused prescription drugs and have more side effects such as drowsiness, nausea, vomiting, dizziness and constipation than over-the-counter (OTC) pain relievers.

When it comes to pain management, we take into account the risk of opioid abuse which has skyrocketed in recent years, particularly in younger people. Their brains are still developing and more sensitive to the effects of opioid use, increasing the potential for addiction and abuse. Studies have found that young people who used opioid prescriptions after a wisdom tooth extraction were at greater risk of using opioids three-months-to-one year later.

Fortunately, contrary to popular belief, opioid pain relievers aren’t necessarily better for pain management than over the counter (OTC) pain relievers.  While there is still a place for opioids in oral surgery pain management, there are regimens using OTC medications and other anti-inflammatory medications that can greatly reduce the need for opioids.

When a patient undergoes oral surgery, most will experience pain and swelling for about three to four days afterward. However, with certain procedures such as wisdom teeth removal, this can last up to a week. The pain level and duration depend more on where the teeth are located, how deeply the teeth were embedded in the bone, and how difficult they were to remove.

Pain Management Options

For most dental patients, post-surgical pain is managed with anti-inflammatory, non-opioid OTC medications such as ibuprofen along with acetaminophen. For those with deeply impacted wisdom teeth or needing jaw reconstruction, an opioid medication might be needed, but will generally be used only for the first several days after the surgery.

Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin IB) and naproxen (such as Aleve). These lessen inflammation, so they are highly effective for pain. And while acetaminophen (Tylenol) doesn’t impact inflammation, it does work to lower your perception of pain. Combining an NSAID with acetaminophen is more effective against moderate-to-severe pain than opioids in patients having wisdom teeth removed and with fewer side effects.

Local dental anesthetics, such as lidocaine, articaine, and mepivacaine, typically last for 2-3 hours after surgery. These anesthetics are used in every procedure, even if a patient is having a general anesthetic or IV sedation.  This allows for local control of pain, and typically enough time to take an OTC pain medication prior to the anesthetic wearing off.  For procedures which can result in more intense post-operative pain, such as removal of impacted wisdom teeth, a long-acting local anesthetic like bupivacaine (Marcaine) is frequently given to last 6-8 hours postoperatively when pain manifestation is usually the greatest.

Post-surgical pain management is begun immediately after a procedure to keep pain levels from building up. Long-lasting local anesthetic use can help immensely. This is followed by a regimen of NSAIDS which is taken on a scheduled basis for 24-48 hours after surgery.  The dosage recommended is dependent on the type of procedure performed.  Acetaminophen (Tylenol) may also be added to increase the level of pain control.  If needed, an opioid is used as a supplement for the pain that is still not adequately controlled.  In addition, a steroid such as dexamethasone may be prescribed for a short period of time to reduce swelling, which also helps a great deal in pain control.  Local measures such as ice packs are also important and very helpful.

In short, it is normal to have some degree of post-operative discomfort following oral surgery.  Our goal is to make this tolerable in the safest way possible, so our patients are able to recover with a minimum amount of downtime. If you have any questions for our team, please feel free to reach out and give us a call today!