Pharmacy rants on Dentistry...

[2quik]

http://forums.studentdoctor.net/showthread.php?t=428566

http://forums.studentdoctor.net/showthread.php?t=218370


Thought these threads were interesting coming from our health professional colleagues .

---

Members don't see this ad.

 

[DrJeff]

That first thread about the root canal really had me laughing

In all seriousness though take a look at some of the concepts/perceptions that non dental people have about what we do and more importantly what they expect us to do. Between the root canal and the dry socket later mentioned in that thread, there's alot you can learn about how ALOT of patients react and listen(or not) to what you tell them to expect/do after your done with the treatment

 

[crazy_sherm]

Maybe if someone told that one guy's wife to brush her teeth, she might have never needed a root canal. I'm sure that's all he needs to hear.

I like how there's one post about someone getting her 4th molars extracted.

 

[DrJeff]

Maybe if someone told that one guy's wife to brush her teeth, she might have never needed a root canal. I'm sure that's all he needs to hear.

I like how there's one post about someone getting her 4th molars extracted.

One of the BEST things you can do that will save you ALOT of time and "silly" questions from patients post treatment, is before you dismiss your patient and send them on their way, take 1 minute and tell them what to expect, what's normal, what they need to contact you about, how long they'll be numb, will they typically have some discomfort afterwards and if so how much and for how long. Sounds simple and like common sense, but you'd really be suprised, especially out in private practice, how few dentists do this, and as a result how many phone calls to the office over simple, trivial things result.

 

[osubum]

So, what are the rules on presriptions? Do they really vary by state, or is it a national law? What are the limits on Dentists? Obviously the dentist is held accountable for his/her Rx, but if you are running your own practice what would happen if you got some loretab (sp?) for your wife for her trip to europe because she hates flying and severly grinds her Teeth when she is nervous???

 

[DrJeff]

So, what are the rules on presriptions? Do they really vary by state, or is it a national law? What are the limits on Dentists? Obviously the dentist is held accountable for his/her Rx, but if you are running your own practice what would happen if you got some loretab (sp?) for your wife for her trip to europe because she hates flying and severly grinds her Teeth when she is nervous???

If its an appropriate Rx and within the normal scope of your practice, then its fine. If you start Rx'ing someone multiple times over a short period of time for a controlled substance(i.e. a narcotic pain med), the pharmacy record that's attached to your DEA# will show this, and you may have to answer some questions from either a DEA agent or law enforcement. (i.e. if you're Rx'ing your wife 100 lortab every week for a few weeks in a row, you'll very likely be getting a call, but if it's 1 rx for a "reasonable" amount of narcotic pain med that's within the scope of a normal drug type for your profession for you, then no big deal).

I know this scenario first hand, since about 40 miles from where my practice is, there's an OB/GYN whose name is the same as mine, only difference is he's got M.D. behind his compared to my D.M.D. Year in and year out, I'll get a call from a pharmacy that's located roughly equi-distant between our offices inquiring me if I really authorized a phoned in refill for birth control pills This is where I'll tell them that you're looking for the OTHER Dr. Jeff, since I work at the other end

I'll also get calls from the pharmacist when I've Rx'd a pain med, and unbeknownst to me, this patient has already been filling Rx's for narcotic pain meds from other Docs recently in the very recent past. Or if you have questions about a patient and possible drug seeking, just a simple call to the pharmacist can yield a wealth of info if they have been seeking pain meds

 

[WVUPharm2007]

Maybe if someone told that one guy's wife to brush her teeth, she might have never needed a root canal. I'm sure that's all he needs to hear.

Look...let's just say you're exceedingly lucky I don't know where you live right now and leave it at that.

I actually knew that some jackass dental student would see that thread then run over here and start their own thread complaining about how insensitive we are toward your profession. Get it straight, *****, I have nothing against dentists, they perform a highly skilled, much needed job. My issue is with the asshat at the school of dentistry that won't give her a few lortabs. Refusing pain medication to a patient whom you just spent an hour making her oral cavity an inflamed ball of flesh isn't good practice. Hopefully you will take this into consideration when you practice yourself. Having crazy sons of bitches like me try to chase you down and kill you because you refused to help end the suffering of one of their loved ones probably isn't something you want to experience regularly.

 

[osubum]

can someone permanently ban this guy???He just made a death threat!

 

[Dr. Dai Phan]

Look...let's just say you're exceedingly lucky I don't know where you live right now and leave it at that.

I actually knew that some jackass dental student would see that thread then run over here and start their own thread complaining about how insensitive we are toward your profession. Get it straight, *****, I have nothing against dentists, they perform a highly skilled, much needed job. My issue is with the asshat at the school of dentistry that won't give her a few lortabs. Refusing pain medication to a patient whom you just spent an hour making her oral cavity an inflamed ball of flesh isn't good practice. Hopefully you will take this into consideration when you practice yourself. Having crazy sons of bitches like me try to chase you down and kill you because you refused to help end the suffering of one of their loved ones probably isn't something you want to experience regularly.

I do understand your frustration. However, there is a way to make your point across without being verbally abusive. The more you shove your anger toward people the more they will be defensive toward you. If you feel your wife did not recieve standard of care at her visit, then I would write a letter to the institution and voice your concern. Again, if you do please be diplomatic and professional. There is no need for name calling or making assault threats. DP

 

[utahdentist2be]

Look...let's just say you're exceedingly lucky I don't know where you live right now and leave it at that.

I actually knew that some jackass dental student would see that thread then run over here and start their own thread complaining about how insensitive we are toward your profession. Get it straight, *****, I have nothing against dentists, they perform a highly skilled, much needed job. My issue is with the asshat at the school of dentistry that won't give her a few lortabs. Refusing pain medication to a patient whom you just spent an hour making her oral cavity an inflamed ball of flesh isn't good practice. Hopefully you will take this into consideration when you practice yourself. Having crazy sons of bitches like me try to chase you down and kill you because you refused to help end the suffering of one of their loved ones probably isn't something you want to experience regularly.

There you go, concrete evidence that you can take the boy out of the trailer park, but you can't take the trailer park out of the boy.

 

[LonestarYankee]

sorry for your wife's bad experience, but i think somebody needs to point out that the vast majority of dental pain is INFLAMMATORY in origin. this is especially true of endodontic pain. since you are a pharmacist to be, i hope you've learned that lortab is an analgesic, whereas ibuprofen is both an analgesic and an anti-inflammatory drug. cox-2 particularly is synthesized in inflamed tissues (e.g. dental pulp). as i'm sure you know, ibuprofen is a non-selective cox inhibitor. assuming your wife (or any patient) doesn't have any GI contraindications, the first line drug would be ibuprofen 600-800 mg. in fact, it would have been best if she had taken 400 mg ibu 1 hour prior to the appointment (to prevent her from developing hyperalgesia) followed by a "by the clock" dosing of NSAIDs rather than prn. if her pain isn't controlled, then a flexible type of dosing regimen could be established (i.e. alternating NSAIDs with APAP). pain management is much more complex than just "writing a prescription for a few lortabs."

Look...let's just say you're exceedingly lucky I don't know where you live right now and leave it at that.

I actually knew that some jackass dental student would see that thread then run over here and start their own thread complaining about how insensitive we are toward your profession. Get it straight, *****, I have nothing against dentists, they perform a highly skilled, much needed job. My issue is with the asshat at the school of dentistry that won't give her a few lortabs. Refusing pain medication to a patient whom you just spent an hour making her oral cavity an inflamed ball of flesh isn't good practice. Hopefully you will take this into consideration when you practice yourself. Having crazy sons of bitches like me try to chase you down and kill you because you refused to help end the suffering of one of their loved ones probably isn't something you want to experience regularly.

 

[DrJeff]

Look...let's just say you're exceedingly lucky I don't know where you live right now and leave it at that.

I actually knew that some jackass dental student would see that thread then run over here and start their own thread complaining about how insensitive we are toward your profession. Get it straight, *****, I have nothing against dentists, they perform a highly skilled, much needed job. My issue is with the asshat at the school of dentistry that won't give her a few lortabs. Refusing pain medication to a patient whom you just spent an hour making her oral cavity an inflamed ball of flesh isn't good practice. Hopefully you will take this into consideration when you practice yourself. Having crazy sons of bitches like me try to chase you down and kill you because you refused to help end the suffering of one of their loved ones probably isn't something you want to experience regularly.

I feel for your frustration over what your wife is going through, however, the care your wife received, with no Rx of narcotic analgesics post endodontic treatment, and the recomendation of NSAIDs is the standard protocol a very strong majority of the time. In my practice, I'll perform over 100 root canals a year, and over 90% of the time, all that I'll recomend post tx is NSAIDs, and with the exception of once or twice a year when the patient presents to my office in extreme and obvious pain pre-treatment will I Rx a narcotic pain med immediately post treatment.

As was mentioned already in this thread, by a large majority, the most common source post endodontic treatment(root canal) pain is inflammation, and in my own practice atleast, I'm much more likely to Rx a Solumedrol dose pack post Tx than a narcotic pain med.

Additionally as a pharmacy student, you should be aware of the large number of folks trying to obtain narcotic pain meds these days, and one of the things that we in the dental field are taught to be warry of, is folks that will request a specific narcotic by name. Whether or not this students attending Doc was aware of your Pharm school status and concurrent knowledge of drug names may have also contributed to the post treatment course of action

 

[OceanBlue]

hehe...i love SDN

 

[PharmDstudent]

one of the things that we in the dental field are taught to be warry of, is folks that will request a specific narcotic by name. Whether or not this students attending Doc was aware of your Pharm school status and concurrent knowledge of drug names may have also contributed to the post treatment course of action

Are you trying to say that they denied her Lortabs, because he knows what they are? That's a load of crap! He also knows what morphine is but didn't think she needed something that strong.
I guess I can't go to my doctor for nerve pain either, because then he might think I want a Lyrica prescription. Just because someone knows the name of a medication doesn't mean they're a dope head .

 

[LonestarYankee]

Are you trying to say that they denied her Lortabs, because he knows what they are? That's a load of crap! He also knows what morphine is but didn't think she needed something that strong.
I guess I can't go to my doctor for nerve pain either, because then he might think I want a Lyrica prescription. Just because someone knows the name of a medication doesn't mean they're a dope head .

true, but when a patient specifically says "i need lortab" or "only percocet works for me," red flags are raised. i think dr. jeff is just trying to point out that providers have a responsibility to control/contain prescription abuse and after you've been burned a few times, you become more cautious.

 

[Dr. Dai Phan]

true, but when a patient specifically says "i need lortab" or "only percocet works for me," red flags are raised. i think dr. jeff is just trying to point out that providers have a responsibility to control/contain prescription abuse and after you've been burned a few times, you become more cautious.

That is true however there are some cases where the provider let the "bad" experience in the past clouded his/her judgments. You need to look at the procedure and then determine if the patient's request is reasonable. If a patient asks me for Tylenol #3 for denture sore in his mouth, then I won't give a single pill even if that patient is a pastor. However, if a person just had a major surgical extraction, then I surely will give out some narcotics regardless. Your foremost responsibility is to relieve the person out of pain and provide adequate pain management afterwards. DP

 

[npage148]

Drug seekers typically don't have root canal's performed for 10 lortabs. Use your common sense when prescribing pain medicine, it's not that hard

 

[Doctor M]

Although NSAIDS may have been the right course of action, perhaps the analgesic would have been appropriate just to relieve the pain. Why not give Vicoprofen (hydrocodone 7.5 and Ibuprofen 200) and supplement that with Motrin 400. That way you have analgesia with antiinflammatory. As pharmacists, we are also trained to look for "drug seekers", but something like a root canal is not something I would like to have just to get pain medicine. No pharmacist wants to "bash" a dental professional and I believe WVU was merely venting as his wife lay in pain. The dental professionals are the experts in something like this, but not all patients repond the same to motrin. Anyway, I had a root canal done in HS and it was the most painful experience I have ever had. I had no pain meds and it was such a horrible experience. It had nothing to do with the endodentist, just my pain threshold.

 

[WVUPharm2007]

There you go, concrete evidence that you can take the boy out of the trailer park, but you can't take the trailer park out of the boy.

Ok, obviously we got off on the wrong foot. You should probably be aware of a few facts:

1) West Virginians actually aren't hicks anymore. That stopped back in the 80s some time. Hell, Morgantown is basically a cultural suburb of Pittsburgh now. If you want "hick" look South and in Kentucky. In fact the only hicks in WV are those located in South WV and in counties bordering Kentucky.

2) I am, clearly, ****ing crazy. As you don't frequent the pharmacy boards, I can't expect you to assume this.

3) You are obviously confused. I don't really care if you make fun of me. However, if a loved one is made fun of, I go ballistic - as illustrated in the following diagram:

About the inflammation versus pain thing (I feel like I'm being lectured about how to add numbers...), she took 800 mg of ibu right after she got home from the clinic...didn't touch the pain. Given how much pain she claimed to be in post procedure, that didn't surprise me...opioid therapy was obviously indicated, IMO. She took a Lortab her family doc back in Philly called in for her and she was feeling fine in 30 minutes. I really don't have any complaint about the profession or anything like that, just a single ahole that chose to not treat his patients properly.

So it's all good.....everybody's happy...moving on....

 

[onelove4uk]

WVU: while i agree it was uncalled for to joke about your wife, insult you, and misunderstand you...isn't a lot of this hindsight bias though? Assuming that the dentist knew that pain is inflammatory in origin, wouldn't he normally just prescribe/recommend ibuprofen to eliminate the inflammation thus relieving the pain? Even though she mentioned she was in a lot of pain, I think doctors are used to seeing patients mentioning a lot of pain where some have higher thresholds than others. I'm not saying your wife has a low threshold, and it seems she legitimately needed pain killers, but I don't think the doctor could've known that and it seems really hard to tell when patients truly need analgesics. it also seems like ibuprofen works most the time but patients won't know until after they take it. but otherwise everyone says they're in pain and dentists can't just prescribe pain killers to everyone when 90% of the time NSAIDs work. unfortunately in your wife's case, it didn't help. BTW, i am a pre-dental so I don't know ANYTHING! if anyone can clarify all this or explain to me why I'm wrong I'd much appreciate it! I've honestly learned a lot just from reading this thread...

 

[All4MyDaughter]

OK. I don't normally address these things in-thread but I want to make sure that everyone understands I'm being objective here.

sherm - making fun of his wife was uncalled for

WVU - your response was over the top. I'm inclined to let it go b/c you've apologized (in your own way - thanks for the drawing).

Dr. Phan & DrJeff - thanks for weighing in and adding some much needed perspective and maturity to this debate.

to the pharmacy and dental students - the issue of proper management of narcotics is important to both of our professions. let's learn from each other rather than slinging mud.

AND I must say - all Kentuckians are NOT HICKS. I should infract just for that.

*group hug, thread closing*