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Dentists Don't Want You To Get Hooked On Opioids

Wisdom tooth removal and even major jaw surgery can now be done without narcotics or prescription painkillers.

DALLAS -- Getting your wisdom teeth removed used to mean an automatic prescription for a strong painkiller, like hydrocodone.

With a nationwide opioid epidemic, where legitimate prescriptions have been known to turn into life-altering addictions, Dr. Pedro Franco of DFW Oral and Maxillofacial Oral Surgery in Irving is taking a new approach.

“I want to make sure I’m going to have a big, nice, healthy community in the future that I can serve,” Franco said. “And the only way I can do that is if I can decrease the amount of opioids that I’m using, and control pain in a different way.”

Franco’s practice is entirely opioid-free. He prescribes zero narcotics – meaning no hydrocodone or morphine - despite performing major surgery.

Patient Jorge Piedra had a four-hour surgery in December 2017. “His lower jaw was growing forward, the upper jaw was backward, and he was not able to actually bite food with his front teeth,” Franco described. “We broke the upper and lower jaw inside his mouth. All his bones were broken, and he didn’t take any opioids at all.”

Piedra is 24.

“Even my mother was like, ‘You’re not taking anything?’” he said. “I was like, ‘I don’t feel no pain.’ You know?”

Franco made the switch to opioid-free for patients who undergo major surgery four years ago, and two years ago for patients having their wisdom teeth removed. He has now treated 900 patients without using opioids.

Instead, he said he uses a multi-modal approach, injecting a long-lasting anesthetic before surgery, using a non-opioid analgesic after surgery and then having his patients take Tylenol or ibuprofen for pain in the days that follow.

“It’s important for us to evolve and realize that some of the stuff we learned in medical or dental or nursing school is completely changing right now,” Franco said. “So, what I propose to my colleagues is to be more open - at least to listen to the new trends on pain management.”

Dr. Todd Kovach owns Trinity River Oral Surgery and Implant Center in Willow Park, just west of Fort Worth. His practice is not completely opioid-free, but he offers wisdom tooth patients an alternative called Exparel. It is a non-narcotic, long-lasting analgesic that’s injected into the jaw right after the wisdom teeth are removed.

“And that releases the local anesthetic into that area, helps block the pain impulse from traveling up to your brain and you don’t feel the pain,” Kovach explained.

“When we use this medication at the time of surgery, we don’t even have to give a prescription for narcotics,” he said. “And I have not had anybody come back and ask for one.”

Using Exparal costs Kovach’s patients about $200 more. Franco uses Exparal, too. The age of their patients is one reason both surgeons made this move.

“Young adults or teenagers, often the first time they’re going to be exposed to opioids is when they get their wisdom teeth out,” Franco said. “And the last thing we want is for one of these patients to like the opioids so much that they’re going to start using heroin or other things.”

Franco believes his practice is an example to follow. “Eventually in the next five years, I think there will be more practices that are opioid-free,” he said. “Slowly but I think surely we’ll get into a point that a lot of people are going to start using normal analgesics for pain control instead of opioids.”

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