While watching television the other night, my husband tuned to a documentary about the opioid epidemic our nation is facing. I half listened to the program while I was finishing up some work on the computer. The program got me thinking about how prescription medications have changed drastically for the dental community and, more specifically, Pike Lake Dental Center over the last number of years.
20+ years ago, when I worked in the front office at Pike Lake Dental Center, it was easy to simply call in a prescription for Lortab. Dr. Matt would prescribe the drug for our patients to control pain associated with toothaches and extractions or large procedures that might cause some discomfort after the anesthetic wore off. The opioid drugs, Lortab in particular, seemed to be miracle drugs. The medication was easy and inexpensive to obtain. It worked really, really well to manage pain. It seemed wonderful… at first. Little did we know as providers, consumers and as an entire society just how dangerous and addicting these drugs would be!
About 10-15 years ago, a shift slowly started to take place. We started to hear more about drug-seekers, people who would call dentists after hours or on the weekends claiming they were in severe pain and hope the dentist on call would choose to prescribe medication over the phone versus going into the office on the weekend. That same drug-seeking individual might call multiple dental offices and also visit the emergency room, attempting to acquire the same prescription drugs in large quantities. Sometimes we heard about these people through our friends in the dental community. Sometimes a pharmacy would tip us off that it was this person’s second or third prescription for the same drug in a short amount of time.
Thankfully, it has been our office policy for as long as I can remember that we DO NOT come into the office in the evenings or on the weekends to see a person who isn’t a patient of record. This policy was put in place to protect our staff from the possible dangers meeting a stranger at night in an empty office might bring. It is also against our office policy to prescribe medications to individuals who are not patients of record at our office, thus relieving us of the decision to call in a prescription for a desperate “potential” patient seeking prescription medications late at night or on the weekends. Instead, we refer them to the local emergency room, which is always open and staffed with extremely capable physicians to help manage pain.
I remember being particularly alarmed and immediately suspicious when a patient would claim, “Only the 10 mg. Lortab tablets work for me. Could I get 30 of them, please?” It seemed awfully convenient that they knew what drug and just how much of it they desired on a Saturday night. Looking back, I wonder how often these drugs were blindly prescribed across America for patients, all parties involved having no idea how harmful and addictive the drugs could and would be.
Slowly, very slowly, we began opening our eyes as a society to the dangers of the prescription narcotics. We, as dental professionals, were also learning more about the addictions patients faced while consuming the drugs. The movement took years and sadly cost many people addicted to opioids their families, their homes, their jobs and, for some, their lives.
Recently, the FDA has clamped down on prescription opioids. The dependencies people have developed to the drugs have reached epidemic levels throughout the United States. Drastic and immediate measures needed to take place to control the opioids and I believe we are starting to see a positive change. Education on the drugs and their potential hazards are more widely shared with the public. We are now aware of the frighteningly fast rate of dependency some people suffer from with opioids.
Today at Pike Lake Dental Center, we almost never prescribe narcotics for our patients. Instead, we give our patients detailed instructions for managing their pain without strong and potentially addictive prescription medications. It is amazing how discomfort can be controlled by means other than potentially addicting prescription medications.
The way prescription opioids are ordered by practitioners through pharmacies has also dramatically changed over the years. No longer can an office simply call a pharmacy and order up 10 tablets of Lortab for a patient. A computer generated, watermarked prescription must be printed and signed by the ordering dentist or physician and be hand delivered to the pharmacy by the patient. We don’t even have the old-school prescription pads at our office anymore. Instead of large quantities of the medications, we now prescribe 2 or 3 pills at a time, not 10, and certainly no refills without carefully monitored patient progress.
As I cleaned out our family medicine cabinet recently, I found some opioids my daughter’s surgeon had prescribed for her a few years ago following a broken arm and emergency surgery. Knowing the risks of these drugs, we had successfully managed her pain with over the counter medications. The entire prescription remained forgotten in our medicine cabinet for years. What was the best way to dispose of the pills? I didn’t want them falling into the wrong hands or harming the environment. I did some research and found some valuable information for safe and local disposal of medications.
If you are looking to safely dispose of any medications you may have at home, please refer to these local websites:
St. Louis County Sheriff’s Office website
St. Louis County website (for our friends on the Iron Range)
Listed on each of these linked websites are instructions and locations on how and where to safely dispose of any unwanted household over the counter or prescription medications, even unused pet medications. If you don’t live near Duluth or on the Iron Range of Minnesota, please search your local county or city websites for more information on how and where to safely dispose of medications. Safely disposing of these drugs is important for people, pets, wild animals and our environment.
As an entire society and as an independent dental practice, I feel we have made great progress to limit the amounts of opioids prescribed to patients. I am thankful that it’s much harder to prescribe and to acquire the drugs than it was just 10 years ago. I’m also thankful we are all finally aware of the dangers of opioids. Knowledge is key, especially when it comes to prescription medications.
Written and submitted by Stephanie Jugovich, staff member at Pike Lake Dental Center
Another change our office made some time ago, was the switch to digital x-ray. Prior to that, we used films that left us blind as to our success until that film took a five minute ride through the automatic processor. Now we see our results instantly! And speaking of the automatic processor -the old AT-2000- it was a machine that was filled with 
chemicals that needed changing on a regular basis, and the chemicals required special testing and disposal. It was also filled with a series of rollers and gears to carry the films through the chemicals. With all those moving parts, as you can imagine, it broke down on a regular basis. Needless to say, we don’t miss it, and are loving our updated equipment. In addition to digital bitewing x-rays, we also have a digital panorex, or full mouth machine. This machine can also take 3-D images to help Dr. Matt and Dr. Meaghan in some procedures they perform, such as dental implants.
it in plaster, heating it to melt the wax, and then melting a gold alloy, and casting it by putting it into a hand-spun centrifuge to force the gold into the mold! Super cool and crafty, but a ton of work … not to mention that it was time away from patients! Now, although there are occasional reasons to send out for a lab crown or bridge, most are done in-office and are typically completed within 1 1/2 hours! AND, beyond that, our office is trained and equipped to offer dental implants!
for appointment times for our patients. As you might expect, after six plus months of flipping through them, adding and erasing names, the pages became quite tattered! I also remember when it was time to move the scheduling to the computer. It would be so much more tidy and efficient to schedule this way! Our receptionist, however, was not convinced! The thought of all those patients helplessly floating in a computer instead of being safe in a book in front of her was daunting! I swear to you, it was like a child giving up a pacifier! The switch was made, and it did, indeed, prove to be just as tidy and efficient as promised … most days!
Gone are the days of hand writing insurance claims and trying to read patients’ accounts off a tiny microfiche that might be a month behind in it’s information. Our computer system keeps staff quite up to date to answer patient questions. Gone, also, are the days of calling every 
patient (which, currently, could easily be up to 50 individuals, or more) to remind them of their upcoming visit. Patients are phoned automatically, as well as having the option of an email or text message.We have also gone “paperless” with patient files. It definitely does not mean less work … I can vouch for this … but, again, it is a much more efficient and secure way to manage our patients’ information!
Written by Deb Trethewey, RDH at Pike Lake Dental Center
