Long Term Opioid Use and Dental Local Anesthesia

Norco opioid pain medication used by dentists

Norco – a common opioid pain medication

As a busy private practice dental office, we are constantly doing dentistry, which involves injections of local anesthesia. Like all dentists, we occasionally encounter a patient and/or tooth that is difficult to get numb. Along this theme, an increasingly common phenomenon we are observing involves difficulty in getting patients numb who are long time users of opioids (often called narcotics).

A common situation is a patient with chronic pain who has been taking an opioid type painkiller long term (such as Percocet, Oxycodone, Oxycontin, etc.). A dental procedure that requires effective local anesthesia is attempted on that patient. During the procedure, it is learned rather quickly that the patient is having difficulty either getting completely numb and/or staying numb. Why is that?

Opioids, Narcotics, Pain Pills, Etc.

The term opioid is derived from the word opium, which is a component of the opium poppy. The raw opium can be processed to produce morphine or heroin – both of which are powerful pain relievers. The term opioid simply means a medication that acts on the opioid receptor.

Opium poppy, the basis for narcotics

The opium poppy – the flower from which morphine and heroin are derived. Image courtesy wikipedia.

Millions of Americans take opioids for both acute and/or chronic pain. For those individuals who take them long term for chronic pain, a tolerance will develop, requiring larger doses. Large doses of opioids taken over time can lead to many long term effects. Many of those effects – constipation, dry mouth, etc. – are well documented. What is not well documented nor well researched is how long term use of these painkillers impacts the effectiveness of local anesthesia.

Long Term Opioid Use and Dental Local Anesthesia

Unfortunately, there is very little “official” information available for practicing dentists and dental students on which to rely. The most widely read and cited textbook on local anesthesia for dentists – A Handbook of Local Anesthesia – by Dr. Stanley Malamed – makes no mention of this phenomenon.

Lidocaine is less effective in opioid users.

Multiple studies have shown lidocaine is less effective in opioid users.

However, a survey of recent research has shown multiple articles which directly and/or indirectly give support to this phenomenon:

  • In this article, opium abusers were compared to non-abusers in their response to lidocaine (lidocaine has replaced novocaine as the local anesthetic of choice in dentistry). The abusers were found to require a longer amount of time for the lidocaine to work. And in addition, a greater amount of lidocaine was required.
  • In this study involving rats, the administration of morphine (an opioid) resulted in a decrease in the potency of lidocaine.
  • In another study involving opium vs. non opium users, chronic users experienced a shorter duration of local anesthesia than non users.

In fact, there is a specific term for a related phenomenon, which is Opioid Induced Hyperalgesia. Basically, those individuals who are chronic users can become MORE sensitive to painful stimuli.

However, despite all of these studies, there remains to be seen a widely accepted theory for a mechanism behind the local anesthesia resistance seen in these individuals.

What This Means for Dental Patients

Unfortunately, because this phenomenon is somewhat new and not well documented, not all dentists are aware of these issues. Some tips:

  • Make sure your dentist is aware of your history. This includes patient with a past history of abuse who are on maintenance doses of naloxone or methadone.
  • Don’t be afraid to say “I’m not numb” or “I can feel this.”
  • If you are still uncomfortable, consider switching offices.

As a modern dental office, we’ve had success treating patients on chronic opioids with either buffered local anesthesia and/or IV sedation. So there are solutions out there – you just have to go out and find them.

Dr. Calcaterra and Team Attend Dental Anesthesiology Conference

In early February, Dr. Nick Calcaterra and his two assistants attended the American Dental Society of Anesthesiology (ADSA) conference in Las Vegas, Nevada. This dental anesthesia conference was designed for dentists focusing on IV sedation and general anesthesia in the dental office setting.

Dr. Calcaterra and his Sedation Assistants at ADSA Conference

The team on a break from sedation training

The conference was held at the ARIA resort and casino, located just off the strip. In addition to participating in the conference, the team also enjoyed the excitement of Las Vegas. We are pleased to report that gambling losses were limited to less than $100 total!

Highlights from the ADSA Conference

Dr. Nick Calcaterra attended classes related to IV moderate sedation. Key areas included:

  1. A survey of newer medications being used in dental IV sedation – specifically dexmedetomidine – in addition to midazolam and fentanyl.
  2. A hands-on demonstration of a tablet/mobile app designed to assist anesthesia providers.
  3. A review of newer medications taken by our aging population – such as anti-coagulants – and how to safely sedate patients on those medications.
  4. And many other topics…
Calcaterra Family Dentistry assistants at Anesthesiology conference

Cyndi and Amanda take a break and pose for a photo.

Cyndi and Amanda – our two rockstar Dental Assistants – attended training – along with other anesthesia assistants from across the country. Highlights from their training included:

  1. How medical marijuana use affects dental sedation and anesthesia.
  2. A review of the same tablet/mobile app that Dr. Nick uses.
  3. Any many other topics…

Why ADSA (American Dental Society of Anesthesiology)

ADSA logoAs one of Connecticut’s busiest sedation dentistry offices – completing well over 100 cases per year – we have an obligation to stay up to date on the latest developments and techniques in dental anesthesia. ADSA is the premier not-for-profit society dedicated to sedation and anesthesia in dentistry.

Dr. Nick Calcaterra is a Master of the College of Sedation in Dentistry in ADSA – which is the highest level a general dentist can achieve. This prestigious certification is held by only a couple of hundred dentists across the U.S. – and he is currently the only dentist in the entire state of Connecticut in private practice to have achieved this honor.

As an office committed to providing safe and effective IV and oral sedation services for dental patients across New England, we stay up to date on all the latest research and techniques recommended by ADSA. We know of no other general dental office in Connecticut with this level of commitment to safe and effective sedation.


Request a sedation consult
Are you interested in IV sedation? Want to learn more? Schedule a consult so you can learn why we are Connecticut’s premier sedation dentistry office for nearly all of your dental needs. Visit this page to request an appointment or call us at (203) 799 – 2929.

What Kind of Dentist Can Put You to Sleep?

What kind of dentist can put you to sleep? As one of Connecticut’s busiest Sedation Dentistry offices, we get this question a lot. So, we’ll address it first with a quick answer:

Any dentist holding a valid sedation and/or anesthesia license can provide sedation or sleep dentistry.

You may roll your eyes as you read this. But the statement is factually correct – and very relevant. A dentist cannot do twilight sedation or general anesthesia without a special license. And this is an answer we give out when we get phone calls regarding IV sedation and “being put to sleep” in our office.

Sleep dentistry and IV sedation in Orange, CT

Very few dentists in Connecticut can provide sedation to make you to feel like this at your next dental visit. Learn which types of dentists can.

Types of Dentists Who Can Provide Sedation Dentistry

In Connecticut, there are three types of dentist who can “put you to sleep” or do “twilight sedation.”

  1. Dental Anesthesiologists – these are specialized dentists who completed a residency in anesthesia. They are highly qualified to put kids and adults to sleep. They provide the anesthesia only – they do NOT do the dentistry. As a result, they always have to work with another dentist who renders the treatment.
  2. Oral Surgeons – these are dentists who completed a 4 to 6 year surgery residency that includes training in anesthesia. They are highly qualified to provide anesthesia to adults and some kids. However, they only provide sedation for surgical procedures such as dental implants or teeth extractions – so if you want to be sedated for a crown or root canal – an oral surgeon cannot do it.
  3. General Dentists or Periodontists with a Sedation License – these are dentists who completed extra training in anesthesia and then pass an exam to provide sedation. In the cases of general dentists, they are able to do most dental procedures with a patient under sedation. Dr. Nick Calcaterra falls into this category.
IV Sedation dentistry by Dr. Nicholas Calcaterra in Orange, CT

Dr. Nick Calcaterra is a general dentist with the training and license to sedate teenagers and adults.

The common element among the practitioners above is that they all have licenses granted through the state of Connecticut allowing them to provide sedation or put patients to sleep.

So Not All Dentists Can Put You to Sleep?

Correct! In fact, very few dentists in Connecticut have the training and license to sedate you.

If you are going to be sedated by an oral surgeon or dental anesthesiologist – then you can relax – you’ll be in good hands.

If another type of dentist offers or advertises sedation, you should make sure he/she has the proper training and license.

IV Sedation License is required to do sedation dentistry

Interested in being sedated in Connecticut? Make sure your dentist has this license!

 

 

 

 

 

 

Unfortunately, there are some dentists within the state of Connecticut who offer “sedation” or “sleep dentistry” but who do not possess the license to do so. We strongly suggest you avoid going to those offices. We only recommend you be sedated by an oral surgeon, an anesthesiologist, or other dental provider with a license to do so. Dr. Nick Calcaterra is fully licensed in the State of Connecticut and is a Master in the College of Sedation – the highest level that can be achieved for a general dentist.

To learn more about what it takes to earn a sedation or anesthesia license, you can go to our page here.

Request a sleep dentistry appointment

Want to learn more about IV sedation with one of Connecticut’s premier sedation dentistry offices? An office that routinely completes over 100 cases per year? If yes, call us at (203) 799 – 2929 or visit this page to request an appointment with Dr. Nick Calcaterra.

Dr. Nick Calcaterra awarded Master Status from American Dental Society of Anesthesiology

Dr. Nick Calcaterra recently sat for and passed the rigorous exam to become a Master in the College of Sedation in Dentistry. This makes Dr. Calcaterra the only general dentist in the entire State of Connecticut who has achieved this prestigious certification who is actively providing IV sedation.

This accomplishment, along with being one of only a select few general dentists in all of Connecticut with a license to provide sedation, has made him the most accomplished sedation dentist in the entire state.

Dr. Nick Calcaterra Master College of Sedation in Dentistry

What is the College of Sedation in Dentistry?

American Dental Society of Anesthesiology

American Dental Society of Anesthesiology

The College of Sedation in Dentistry was created and is maintained by the American Dental Society of Anesthesiology. ADSA, as it is called, is the professional organization representing dental professionals who employ advanced forms of sedation and anesthesia to patients.

The College of Sedation is designed primarily for general dentists and periodontists who wish to further their anesthesia skills. Achieving Master Status – which is the highest level a general dentist or periodontist can achieve – indicates that the provider has complete mastery of all the skills needed to perform IV sedation in his or her office. The rigorous prerequisites – along with a three hour board exam – make it extremely difficult for providers to achieve this status.

Why Sedation Dentistry with Dr. Nick Calcaterra?

Dr. Nick Calcaterra’s vast experience and expertise in sedation for dental patients is what sets him apart. And becoming the only general dentist in Connecticut to be admitted as a Master is testament to his commitment and knowledge.

Dr. Nick Calcaterra Master College of Sedation

Dr. Nick Calcaterra with his two Anesthesia assistants Cyndi and Amanda.

Dr. Nick averages over 100 sedation cases per year, performing procedures such as extractions, root canals, and even simple fillings. For Dr. Calcaterra, sedations are an almost daily procedure. Most other sedation providers – assuming they even have a sedation license – average only one or two cases per month.

Our vast experience in providing twilight anesthesia to patients – along with our caring staff – and Dr. Calcaterra’s deep expertise – are why Connecticut patients choose our office.

Sedation Dentistry requestAre you interested in learning more about sedation dentistry? Then you’ve come to the right place! Go to this page to request a consultation or call us at (203) 799 – 2929. Dr. Nick and two assistants Cyndi and Amanda will be happy to help you.