It all started with the poppy!
Remember from the Wizard of Oz, when the wicked witch of the east said “Poppies will make them sleep?” Well, she was right on!
1) Narcotic medication originates from the opium that is found in poppies. Morphine and codeine are made synthetically in a lab and both are used to control severe pain.
2) Codeine is used more commonly than morphine in controlling pain.
3) Narcotic medication acts by binding to pain receptors in the Central Nervous System (C.N.S), which consist of the brain and spinal cord. They attach themselves to the pain receptors and don’t allow the sensation of pain to be felt. In addition, they are used to treat coughs and diarrhea.
4) They also cause a drowsy and sleepy effect, so it’s always advisable not to drive when on them. In addition, don’t combine them with other drugs like benzodiazepines and anti-histamines, because these drugs also cause drowsiness and the effects can be cumulative.
5) The downfall of a narcotic is that you develop physical and psychological tolerance and dependence to them over time. This means that after taking them repeatedly, you need more of a dose to have the same pain reducing effect until they’re no longer effective. But your body still craves them.
In addition, narcotic medication is broken down by the liver, so if you have liver problems, they won’t be broken down and they will accumulate to high levels and possibly lead to an overdose.
Since narcotic medication is used mainly for severe pain, we tend to stay away from them in dentistry. However, Codeine does come in a variety of strengths, so it can be used in certain situations where the level of discomfort after a procedure may be higher than expected.
1) Whereas the narcotic medication just masks the symptoms of pain by binding to pain receptors in the C.N.S, the anti-inflammatory’s go straight to the site of the actual inflammation and get to work…they try to clean up the mess.
There are different types of anti-inflammatory medications such as the steroid and non-steroidal groups. We will look at the non-steroidal group, otherwise known as the NSAID’s (non-steroidal anti-inflammatory).
2) Inflammation is caused by Prostaglandins that are produced when an injury arises. The prostaglandins result in tissue destruction. The NSAIDs work by preventing the production of prostaglandins. If you want to get technical, they cause the ‘irreversible acetylation’ of cyclooxygenase, which is an enzyme that produces the prostaglandins, so the enzyme that is needed to make the prostaglandins, doesn’t work.
3) Motrin (Ibuprofen) is an anti-inflammatory which comes in a variety of strengths and is used quite often in dentistry. It is used to treat mild to moderate pain, which is typically the pain you experience after a basic dental procedure like an extraction or a root canal.
4) The drawback of the NSAID’s is that if used over a long period of time, they can cause gastric ulcers. This is why it is better to use them for acute rather than chronic pain. They can also have a bad effect on the liver and kidneys if used long-term.
5) In addition, the N.S.A.I.D’s have a ‘ceiling’ effect. This means that after a certain dose, they don’t provide any more pain relief. With narcotic medication, the higher the dosage, the greater degree of pain relief. However, unlike narcotics, there doesn’t seem to be a problem with developing tolerance to the N.S.A.I.D’s.
The next blog would have been a good time to discuss other medications that are used in dentistry, but I think we should choose a topic that’s a little lighter, so for now…Pharmacology 101…class dismissed!
About Dr. Axelrad
Practicing dentistry for more than 23 years, Dr. Robert Axelrad has owned and managed his own dental practice since 1997. He moved his practice to its current, state-of-the-art dental office in Brampton, Ontario in 2002 to accommodate his growing list of happy patients.