 Parker Ewing spent a sleepless night due to dental pain. In the morning, he drove to a local urgent care clinic so that he could be examined and get a medication to stop the pain. He came away frustrated and dissatisfied with their treatment suggestion, which was an over-the-counter pain medicine, a setaminophen. The physician noted that there was a dental emergency clinic nearby and perhaps Mr. Ewing could get some relief there. He proceeded to the clinic. The dentist there immediately reviewed Mr. Ewing's dental history and performed a limited oral evaluation, followed by a panoramic radiograph to gain an understanding of the patient's oral condition and any sources of pain, including infection. Dr. Tappell addressed Mr. Ewing about his situation. Mr. Ewing, let's talk about the results of my examination and your radiographs. Great. Can you help me? I'm in a lot of pain. I'll do my best, Mr. Ewing. I've found that you have multiple decayed teeth, but especially three problem teeth on the upper left part of your mouth that may be causing the pain. There is also some likely chronic infection in that area. Now, I believe that those three teeth need to be extracted because they cannot be restored. I really don't think there's an alternative to removing them. There is simply not enough tooth structure remaining due to the condition of advanced decay. From an options perspective, I don't really see any other options available. Okay. I'm all for removing them. If it'll get rid of the pain, I'll do it. All right. If you agree, we can do the work today. No. I can't do it today. I have to be at work in about an hour. Could we schedule for tomorrow? Unfortunately, I'm afraid our appointment schedule is full tomorrow. But we have walk-in hours available from 8 to 10 a.m. Well, that doesn't work for me. I guess I'll have to figure out some other way to deal with this. You at least have to give me some pain meds. I can hardly stand this. What I'd recommend is that you take 600 milligrams of ibuprofen every six hours. And if there's any breakthrough pain, I'd recommend that you alternate with the acetaminophen as your physician prescribed. No, no, no. You have to give me some pain pills. That over-the-counter stuff just doesn't work for me. Mr. Ewing, we'd like to use ibuprofen because it has the anti-inflammatory properties that would help control the pain right now. And research has shown us that the pain control effects of combining ibuprofen with acetaminophen is highly effective and beneficial. Look, the only thing that worked for me at all was some pills my wife had left over when she had some back surgery. It was trichodin or bicodin, something like that. Was it perhaps bicodin with a V? That sounds right. Yeah, bicodin. Those worked. Those are what I need. I hear your concern. Bicodin just isn't indicated right now because it lacks the anti-inflammatory effects of the ibuprofen. And your pain will diminish greatly once you're able to have those teeth extracted. Okay, fine. I just wasted 99 bucks with you people. I am in pain. I need pain pills, and none of you will get me relief. This is malpractice. You charged me for nothing. Mr. Ewing, the V covered the examination and the X-ray so I could diagnose what your problem was. Fine. I guess I'll just have to go somewhere else to get this pain treated the right way. I came here for help and you give me nothing. What are the ethical and professional issues raised by this scenario? You may pause the video to consider this question. Let's look at a few possibilities that may have occurred to you. You may pause the video after each possible solution to consider the implications of each option. Should Dr. Tappell refuse to prescribe the narcotic and, as kindly as possible, dismiss the patient, refuse to prescribe the narcotic if she suspects the patient is a substance abuser and discuss these concerns with the patient, try to calm down the patient and convince him to take the over-the-counter anti-inflammatory and analgesic and have him return to the clinic early the next morning, prescribe the narcotic but only enough for one to two days asking the patient to return for treatment, check the prescription drug registry or monitoring program to access the patient's prescription drug history to investigate any concern of abuse. Now let's look at a few contributing factors as you weigh what is important in your considerations. Wanting to help a patient that is in genuine pain. The obligation to attend to dental emergencies. The possibility that the patient is drug-seeking. The patient's judgment and decision-making may be clouded by the intensity of legitimate pain. Not wanting to become the local narcotics dealer and have your reputation suffer. Many dental practitioners face ethical dilemmas such as this one on any given day. Anticipating how you might deliberate to find a suitable resolution to any such dilemma is good preparation and can aid each practitioner to find appropriate solutions to the challenges they sometimes must face.