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Dear Colleagues and Friends,

Over the course of the past year, global awareness of the narcotics epidemic has increased thanks to the attention of the government and various media outlets who have highlighted the severity of the situation.

When I was teaching full time, I was shocked by the amount of narcotics prescribed in the undergraduate oral surgery clinic. Narcotics were
prescribed for almost any type of dental extraction, ranging from simple to more complex cases. I actually used to call the clinic the “Lortab Clinic”. These issues can be attributed mainly to the educational system. As instructors, we did not emphasize the indications or the usage of other modalities for pain management. We also believed that we lacked compassion if we did not give our patients the “strongest” pain medications. Pre-surgical pain evaluations of the patients were not recommended, nor did we discuss previous pain management methods with the patient. Had these steps been followed, the patients may have become more aware of narcotic analgesics and their potency on pain control.

Unfortunately, in other situations, practitioners believe that their lifestyle would be jeopardized if the patients were not given the “stronger” analgesic. Less medication would result in more postoperative phone calls and visits. We, as the leaders in the surgical treatment of dental and maxillofacial pathology, including the extraction of third molars, should guide the change of pain control methodologies. This must begin with proper education and patient management utilizing a multimodal therapy for pain control. Remember that many of our young patients will be exposed to narcotics for the first time during sedation and postoperative pain management. It is crucial that we be open to changing our way of thinking and practicing. Let’s increase our awareness of old and new modalities for presurgical pain evaluation, sedation, and pain management, including counseling in select cases, so that we may continue to provide the best patient care possible.

I have been in practice for almost 20 years and am not resistant to change. I have been implementing new therapies and approaches such as long-acting local anesthesia, as well as using old therapies to enhance multimodal pain management after surgery. I do this in an effort to minimize the usage of narcotics on my patient population. I am happy to announce that ACOMS will be leading an educational activity within the next few months, led by Dr. Deepak Krishnan, on multimodal pain management and narcotics analgesia.

This month we remember 15 years since the September 11 terrorist attacks. These attacks were not just a threat against the United States, but to the world as a community. Always remember the victims and our heroes, whether living or fallen, and pause for a moment to reflect on the changes to our freedom and our way of life since this tragedy took place.


Pedro F. Franco DDS
ACOMS President

Read Dr. Franco’s published article in the full version of the ACOMS Newsletter here (right-click to download).