Case 5

Initial Presentation: A 16-year-old female presents for consultation for third molar extraction. She reports no significant medical history and no contraindications for routine dental care. Radiographic assessment reveals that her third molar teeth are fully bony-impacted and it is anticipated that she may experience significant post-operative discomfort upon extraction. She has never had any surgical procedures before and has never taken opioid pain medication.

Action Plan: Discuss with patient and guardian the anticipated discomfort levels associated with the proposed procedure and the preferred first-line protocol for pain control. Discuss the risks associated with early exposure to opioid medications, proper storage and disposal and the risks of diversion and misuse. Consider long-acting local anesthetics and use of appropriate steroidal and non-steroidal anti-inflammatory medication to mitigate swelling and discomfort.

Conclusion: Patient was given a prescription for ibuprofen, acetaminophen, and was given IV dexamethasone prior to dismissal from the office. Patient was also given a prescription for a 3-day supply (8 tablets) of an opioid, which she did not fill and reported minimal discomfort after 48 hours at all post-operative visits. Patient and guardian stated that they appreciated the discussion about the risks and benefits of different pain control regimens and understanding normal levels of postoperative discomfort gave them peace of mind that they are receiving ideal care.