“Can I get some Vicodin Doc….??”
As prescribing doctors, how often have we written a script for Vicodin, Vicodin ES or Percoset? You do a simple extraction, possibly place bone grafting material, and you end up either writing a script for a narcotic, or perhaps you’re cell phone rings that night with a simple request…”Can I get some Vicodin doc, I’m in a lot of pain?”
We all have been there, sometimes wondering if our patients really needed the narcotic drugs prescribed to them. In a recent lecture I did in Escondido to a group of dentists, I was blown away at what a doctor in the audience told me at the end. After the audience so kindly clapped at the conclusion of my lecture, I saw his hand tremble up as to make a statement. I called on him. It took him a couple seconds to speak. He explained how two months ago he refereed his brother in-law to an oral surgeon for extractions of #14 and #15. He indicated that he refereed his brother in-law for the extractions simply to avoid the post op “embarrassment” that was to follow. He did not want to be seen as the dentist who extracted two teeth from his own family member’s jaw.
That night after his extractions his brother in-law passed away. He was prescribed Vicodin ES and took 1 at 6pm and 1 at 9pm before he went to bed thinking it would help
him sleep through the discomfort. Well considering the fact that his brother in-law had severe apnea and refused to try CPAP and was not aware of any other options, the
combination of the narcotics and OSA proved to be deadly.
We always see the board certified sleep docs recommend on their Sleep Study results that alcohol and narcotics should be avoided, well at least that’s what I see from the docs from Sleep Services. And as my attendee choked up finishing up his story at the end of my lecture, I realized that we are all in this for many reasons. We all want to help patients who have this profound disease, but nothing is more powerful when it hits close to home. It could be your family member, your patient that you prescribed a narcotic to after a complicated dental procedure. Could this push the patient over the edge?
This is where a thorough review and discussion of sleep apnea comes into play with our patients. If one suspects sleep apnea is at play; obesity, large scalloped tongue, retruded lower jaw, bruxism, etc, etc…think about what you are prescribing and let patient understand that taking narcotics before bed time may cause the apnea if any to worsen.
I know when I lecture to dentists across the country, I always learn something myself, and I have realized we all care about this disease. The education and discussion of OSA
is crucial to understand it better in order to allow us to become better clinicians.
Dar Radfar DDS practices in Thousand Oaks California. Dr. Radfar is accredited by the American Academy of Dental Sleep Medicine. Since 2007, he has been treating Sleep Apnea and Snoring patients. He provides professional lectures on the practice of Obstructive Sleep Apnea dentistry, how to screen for the condition, types of appliances to use, and how to get reimbursed for the services provided through medical insurances. For information on these lectures http://conta.cc/1iLSdMG