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Letter From Dear Doctor

Issue 36 of Dear Doctor Magazine

Overuse of Medications: A Prescription for Trouble

Every so often, an issue comes along that compels us to look at how things have been done in the past, and ask whether it’s time for a change. Today, that issue is the growing epidemic of opioid addiction.

Scan the news and you can’t avoid seeing the grim statistics: Drug overdose is now the leading cause of death for people under 50 in the United States, and the misuse of prescription opioids is driving this trend. The death toll from opioid overdose has quadrupled since 1999; at present, these drugs are responsible for some 91 fatalities each day in the U.S. alone.

What does this have to do with dentistry? Plenty. The vast majority of opioid abusers started out by taking prescription pain medication—either their own, or pills they were given by a friend. And for people age 10-19 years, dentists are the leading prescribers of opioids. What can we do differently? In this issue of Dear Doctor, we explore alternatives to these medications in Are Opioids (Narcotics) the Best Way to Manage Dental Pain? The author, Dr. Harold Tu, is a leader in the effort to develop newer and safer protocols for pain management in dental procedures.

Yet opioids aren’t the only drugs that raise concerns. For many years, women (and men) in danger of developing osteoporosis have been prescribed medications such as alendronate (Fosamax™) and denosumab (Prolia™). However, evidence shows that taking these drugs for an extended period of time can cause serious problems—including a condition called osteonecrosis, which causes bones in the jaw to die. If you’re taking osteoporosis medications, Dr. Robert Marx, a noted oral surgeon and researcher, shares some information you need to know in Osteoporosis Drugs and Dental Treatment.

The overuse of prescription medications can have consequences not just for individuals, but for society as a whole. In past issues, we’ve looked at the excessive use of antibiotics—a problem not limited to dentistry, but one that affects us all. Current research indicates this is still a critical issue. For example, a recent study showed that some antibiotics used in dental procedures weren’t always needed, but could cause an increase in drug-resistant bacterial infections.

Dentistry, like every scientific field, is constantly evolving as new discoveries are made. When it’s time for the status quo to change, we all have a part to play. Policy makers need to look at alternatives to currently accepted protocols and standards. Medical professionals must question whether “the way it’s always been done” is the best way to move forward. And patients owe it to themselves to become educated about the issues, and to ask appropriate questions. With the articles we present in each issue, our goal at Dear Doctor magazine is to help you be an informed participant in these discussions.


Mario A.Vilardi, DMD