Jaycee Brown

Jaycee Brown

Director of Communications

Alternatives to Opioids and Coverage

Dentists usually prescribe opioids to patients experiencing dental pain (Metro-Sanchez). While opioids help mitigate this pain, they cause the patients’ bodies to “release a hormone called dopamine. Dopamine causes [them] to feel pleasure, which could lead to addiction” (“Opioids”). Also, some side effects that patients may experience include constipation, drowsiness, and nausea and vomiting (Bhargava 2018, 2). Furthermore, when patients immediately “stop taking [the opioid]” after a long time, they can experience withdrawal symptoms, for example, diarrhea, nausea, vomiting, muscle pain, anxiety, and irritability (Bhargava 2018, 2). When people use them incorrectly, such as consuming more than prescribed, they can experience “‘severe respiratory depression and death’” (“Opioids”; “Opioids: Know the Risks” 2018). Due to the risks associated with opioids, dentists must educate patients on these risks. They could even provide alternative treatments that may be covered by the patient’s dental insurance policy.
Alternatives to opioids could help patients deal with pain without dealing with the risks associated with opioids at affordable prices with coverage. In fact, according to Joseph P. Crowley, president of the American Dental Association (ADA), “The data on opioids finds they are not as effective as other treatments and are associated with more adverse events. Often some combination of nonsteroidal anti-inflammatory drugs (such as ibuprofen, naproxen, etc.) and acetaminophen or aspirin can be just as effective” (2018). Consequently, dentists should offer patients the choice to take “non-opioid alternatives for post-operative pain control, including oral surgery procedures such as wisdom teeth extractions” (Dominion National 2018). Another alternative in addition to nonsteroidal anti-inflammatory drugs include “[sustained] release therapeutic drugs, such as EXPAREL, [which] are injected at the surgical site during the procedure and can relieve pain for the first few days after surgery” (Dominion National 2018). Fortunately, there is a new code in 2019 for this procedure, which is “D9316-infiltration of sustained release therapeutic drug-single of multiple site” (DiGangi 2018). Some insurance companies cover this procedure. For instance, Dominion National provides coverage for this procedure in an effort to provide other options to dentists and patients (Dominion National 2018). Additionally, Aetna covers EXPAREL as well as liposomal bupivacaine, “a non-opioid alternative that oral surgeons can use in conjunction with extractions of impacted third molars” (Metro-Sanchez; “Opioid Alternatives”).
These non-opioid alternatives not only help patients avoid opioids, but can also be covered by their dental insurance policy. However, some people may need opioids since “[approximately] 20% of patients either cannot take pain relievers like Tylenol or Advil, or they require more intense pain relief after oral surgery” (Tatomir 2018). Before choosing their prescription, they should talk to their dentists about their options for best managing their dental pain (“Opioids”). For those that can safely take non-opioid alternatives, they should review their dental insurance policy in order to check whether they have coverage for those alternatives.

Works Cited
Bhargava, Hansa D. “Opioid (Narcotic) Pain Medications.” WebMD, September 20, 2018.
Page 1: https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1. Page 2: https://www.webmd.com/pain-management/guide/narcotic-pain-medications#2.
Page 3: https://www.webmd.com/pain-management/guide/narcotic-pain-medications#3.
Crowley, Joseph P. “A message from the ADA president.” ADA American Dental Association,
January 22, 2018. https://www.ada.org/en/publications/ada-news/2018-archive/january/a-message-from-the-ada-president.
DiGangi, Patti. “Important changes and opportunities with CDT dental coding 2019.”
DentistryiQ, December 11, 2018. https://www.dentistryiq.com/articles/2018/12/important-changes-and-opportunities-with-cdt-dental-coding-2019.html.
Dominion National. “Dominion National to Cover Non-Opioid Treatment Alternative to Control
Dental Pain.” nadp National Association of Dental Plans, November 12, 2018. https://www.nadp.org/PressReleases/PressReleasesArchive/2018/11/12/dominion-national-to-cover-non-opioid-treatment-alternative-to-control-dental-pain.
Metro-Sanchez, Amber. “Alternatives to dental opioids.” RDH. Accessed January 10, 2019.
“Opioid Alternatives.” aetna. Accessed January 10, 2019.
“Opioids: Know the Risks.” Cigna, March 2018.
“Opioids.” Mouth Healthy. Accessed January 10, 2019.
Tatomir, Shelby. “Pain Relief After Oral Surgery.” Delta Dental of Iowa, August 14, 2018.


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