dentists and prescriptoins

opinion guy

I have a question for the dentists on here.
I had major pain problems recently and went to see someone. Anyhow infection etc blah blah. The dentist suggested difene for the pain. I told her that I could not tolerate difene as I get heartburn etc etc. She kind of ignored me and prescribed it anyhow. She did not prescribe anything gastroprotective like a ppi. Of course I didn't take it and the antibiotics taken the pain down to tolerable levels anyhow

I'm a little taken aback that a dentist would prescribe me a medicine that I told her i had contraindications against, and then NOT prescribing a ppi along with it. I mean thats potentially dangerous

Is this normal practice for dentists ?

davo10

Heartburn is not dangerous, it is a little uncomfortable but given a choice between acute dental pain and heartburn, most people would put up with a little heartburn. Heartburn is a side effect, not a contraindication. Dentists have a list of medications which we can prescribe, i'm not sure that there are any GIT medications on it (i certainly have never prescribed them). Your chemist could have recommended a mild remedy eg gaviscon. Lastly, if the pain was severe, ibuprofen etc would not be stong enough and difene is an excellent anti inflammatory. The other painkiller i prescribe is ponstan, that also can cause heartburn.

btkm8unsl0w5r4

Beer gives me heartburn, I still drink it though.

davo10

with me its indian food, but i love it, heartburn and all

opinion guy

ok now I'm even more taken aback.

Heartburn as a symptom in and off itself is not dangerous. But its a symptom of things that are, such as ulcers and erosions. Things that bleed. Things that are especially likely to bleed in the presence of stress, such as extreme pain, and in the presence of drugs such as COX inhibitors, such as difene and ponstan. Especially when used without something gastroprotective like a ppi or H2 blocker. Ibuprofen is the easiest of the NSAIDS on the stomach and even it still causes these problems. U basically won't get prescribed an NSAID other than low dose aspirin in a hospital without being put on a ppi. People put on these drugs inappropriately can and do develop ulcers and GI bleeds. Its dangerous.

You do know also not to give NSAIDS to people with chronic kidney disease, right ?

You guys are really funny and all but I'm actually being really serious here. Read up on it because you don't want to be prescribing these meds to the wrong people. Seriously.

davo10

Were you diagnosed with any of these ailments prior to your dental visit? were you vomiting blood, have acute pain from intestines, excreting blood in faeces, have blood pressure problems? if you were, did you tell your dentist?.

You stated that you "get heartburn" when you take difene, this indicates that it is a side effect associated with something you are ingesting, not evidence of a pre existing pathological condition. Lucozade gives me heartburn, everytime i drink it i don't automatically think i must have gastric or renal problems, I just think lucozade gives me heartburn.

Antacids are often prescribed by GPs/hospitals when patients have pre-existing conditions, are on longterm medications or to make short term courses more comfortable, if your difene/antibiotics did not give you relief after a brief time, then root treatment/extraction is indicated, not further medications.

You do not mention any other symptoms which would indicate that you have underlying health issues, to be honest a little heartburn may be a small price to pay for relief from acute dental pain.

btkm8unsl0w5r4

Opinion guy, you have all the lingo, I am guessing you are in some form of medical training at the moment?

Big_G

Tell the dentist you have an ulcer and you won't be prescribed a cox inhibiting nsaid. You'll be given a weak children's painkiller like calpol that won't do anything or codeine that will make you constipated.

Most patients coming in don't know their medical history and the ones that do don't understand it. So we use our better judgment sometimes in prescribing. It comes along with the licence. Do you have a licence to prescribe?

So climb down off your horse for a second.

Dentists are not limited legally in what we can prescribe, just ethically.

Big_G

God be with the days we could give nimesulide.

I'm just reading the posts again and I find you an arrogant so and so. You're speaking to two qualified and experienced clinicians.

Post your evidence of studies that show short term use in people with no other contraindications or history can cause life threatening gi bleeds. And then post one for the support of use of ppis in short term nsaid therapy. Like 5 days worth, which is the standard prescription in dentistry.

Your dentist was giving you that prescription for your comfort! The standard of care is to reduce the symptoms by treating the source of infection ie drainage by removal of tooth, root canal therapy or incisional drainage. Antibiotic therapy will temporarily remove the symptoms of an infection of odontogenic origin. Thank your lucky stars you got an nsaid. You might have got nothing at all. In fact, I was taught in college not to prescribe analgaesics by one lecturer because it was merely treating symptoms. So now.

opinion guy

Ok. Right I actually value my privacy so I'm not talking about how I know what I know or what my medical history is on here.

Suffice it to say this: I have contraindications to NSAIDS. I told the dentist this. She was extremely blase in response and prescribed them anyway. At the time I was in too much pain to challenge this (I had no intention of taking the difene anyway knowing it would give me worse problems than i already had - I'd rather deal with the dental pain as blinding as it was).

I came on here to ask was this normal practice for dentists because I found it concerning. The fact is the dentist did not even ask me had I GI troubles or kidney troubles (and whatever about the GI side, 5 days of NSAIDS is MOST DEFINITELY enough to cause renal failure in someone susceptible). So you can find me as arrogant as you want as I only wanted to raise awareness of this. For your patients and your own sake, if you are gonna prescribe NSAIDS for anyone you NEED to actually ask them about GI issues and renal issues as opposed to assuming they just don't have them.

And if you don't want to take my word for it then go ask a doctor friend about it

Big_G

As previously stated, heartburn is not a contraindication to prescribing nsaids. If you had kidney problems you would know to make sure not to take nsaids. You came on here to lecture dentists about their inferior pharmacological knowledge, not out of concern for other patients.

I get patients all the time who think they may have an allergy to penicillin. When I ask them how they know they say they are not sure. On further questioning it is revealed that they have never been tested and have never had an anaphylactic reaction to penicillin. They may have felt stomach sick when taking it before. That is not an allergy. I still err on the side of caution and do not prescribe penicillin or analogues.

If you think you may have a contraindication to a particular medication, say it to the dentist. Don't say, I might get heartburn. That is not a contraindication. It is the patients duty to be forthcoming with a complete medical history to the dentist, and it is the dentists duty to ask.

opinion guy

As previously stated, heartburn is not a contraindication to prescribing nsaids.

I'm not talking about heartburn. Sorry I should have clarified that earlier. I don't want to say what I am talking about. Suffice it to say I have a contraindciation. what concerns me is that the dentist didn't listen and didn't ask questions about that.

If you had kidney problems you would know to make sure not to take nsaids.

You can't just assume that.

You came on here to lecture dentists about their inferior pharmacological knowledge, not out of concern for other patients.

Don't presume to know what my motives are. Now THAT is arrogant. I am genuinely shocked and concerned about this.

It is the patients duty to be forthcoming with a complete medical history to the dentist, and it is the dentists duty to ask.

Excuse me? The patients duty ? The patient does not necessarily know what is relevant. Furhermore the patient is somtiems preoccupied - with things like pain and the precise details of their medical history may not be pressing in their mind at that time. And she didn't ask. I said I have a contraindication but didn't say more because I was in so much pain I could barely stand up. Had she asked more I would have been pissed off I had to talk more, but I would have told. You can't just assume people will tell you things.

Big_G

In a relationship between healthcare provider and patient, both have responsibilities. How can a healthcare provider design a treatment plan with limited information? This information a lot of the time can only come from a patient.

You are only agreeing with what I said previously when you say that the patient doesn't have a responsibility in this regard.

Why don't you complain to your dentist instead of lecturing us?

I'm closing this thread for now, because I've paid my dues with five years of study and several years of clinical experience in this regard. I don't feel the need to be lectured by someone with no apparent qualifications or experience.

Good luck getting down off of your high horse.

btkm8unsl0w5r4

opinion guy aka quacksalber, mods can see that your ip address is identical ( and your personality shines through regardless) and that you signed up two accounts with the sole purpose of giving out about the dental profession (and doctors from your post history!), a I am guessing you are in biochem or pharm, prob in training cause only those without clinical/life experiance see the world in black and white . I have had enough of this rubbish. Concern yourself with you own oral health and stop spreading fear and doubt about dentists/doctors on this forum. One more infraction from "either" of you lead to a ban...end of.

tbh

mod note: I'm posting this on behalf of Opinion_guy.

Opinion_guy isn't banned from this forum, it's just that we wanted to leave this thread closed, and the easiest way to acheive that and still let him have his say was for me to post:


Update from opinion guy. On recommedation from a friend I found a new dentist/oral surgeon who I am very happy with. The new dentist was far more professional, respectful and qualified than the first one and told me I had in fact been prescribed the wrong antibiotic by the first one. My new dentist also disagreed with some of the things the first one said. It would seem the first dentist was just crap. Anyhow, I am now -1 wisdom tooth and very happy with the results. As regards my contraindication, the test results I was waiting on came back normal so that problem has gone away and i could take ibuprofen post extraction - thou barely even needed it such a good job was done.

FYI - my new dentist also does not use amalgam fillings unless absolutely necessary.

Opinion guy is happy. However I do wish to say, I've been accused of having a 'problem' with dentists. I woulnd't exactly agree with that. I do have problems with specific dentists I've been to who have treated me unprofessionally and that is what prompted this thread.