MedicalResearch.com Interview with:
Dr. Katie Suda, PharmD, M.S.
College of Pharmacy
University of Illinois at Chicago
Dr. Susan Rowan, DDS
Clinical Associate Professor, Executive Associate Dean of Clinical Affairs
College of Dentistry
University of Illinois at Chicago,
MedicalResearch.com: What is the background for this study?
Dr. Katie Suda: Dentists treat a lot of pain – we have all probably had the experience of a terrible tooth ache. All dentists treat pain worldwide so we would not expect a large difference in which pain medication is prescribed. However, our results show that US dentists prescribe opioids more frequently than is likely needed. This is especially true because studies have shown that non-opioid pain medications are similar or more effective for the treatment of oral pain.
MedicalResearch.com: What are the main findings?
Dr. Katie Suda: We found that dentists in the U.S. prescribe opioids 37 times more frequently than dentists in England. US dentists were also more likely to prescribe opioids with a higher potential for diversion or abuse – 1 in 10 opioids prescribed by US dentists were those considered to be high potential for abuse or diversion. UK dentists did not prescribed these opioids. (This is expanded on below.)
MedicalResearch.com: What should readers take away from your report?
Dr. Katie Suda: Patients should communicate with their dentist on the most effective pain medication after dental procedures and if an opioid is needed. Their pharmacist can provide patients with recommendations on over-the-counter pain medications and screen for drug-drug interactions with other medications patients are prescribed by all of their providers.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Dr. Katie Suda: Patients should communicate with their dentist on the most effective pain medication after dental procedures and if an opioid is needed. Their pharmacist can provide patients with recommendations on over-the-counter pain medications and screen for drug-drug interactions with other medications patients are prescribed by all of their providers
Dr. Susan Rowan : The study is a certainly wakeup call, encouraging greater consideration of abuse potential and alteration in prescribing practices among U.S. dentists, including choosing non-opioid alternatives in pain management. The opioid epidemic is a complex issue that is being addressed in multiple ways. This study used a dataset from 3 years ago, and since that time, work on educational changes have occurred in the oral healthcare field. The American Dental Association and the American Dental Education Association recognize that the opioid epidemic is a major public health concern that needs to be addressed from all fronts.
The American Dental Association released a policy statement in March, 2018 to that end. The “new policy on opioids supporting mandates on prescription limits and continuing education in what could be the first of its kind among major health care professional organizations”. Furthermore, the ADA “supports mandatory continuing education in prescribing opioids and other controlled substances; statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with the Centers for Disease Control and Prevention evidence-based guidelines; and supports dentists registering with and utilizing Prescription Drug Monitoring Programs (PDMPs) to promote the appropriate use of opioids and deter misuse and abuse” .
The American Dental Education Association also released an Executive Summary in March, 2018, which recognizes that “the impact of the opioid epidemic has been felt in communities in all 50 U.S. states. Curbing the epidemic’s exponential trajectory requires special attention from dental educators. Academic dental institutions are using a variety of methods to mitigate substance misuse, including curriculum and clinical protocol changes. Dental educators are key to teaching best practices in prescribing to the next generation of practicing dentists. This policy brief highlights strategies that demonstrate academic dentistry’s contributions to combating the opioid epidemic. To address this trend, dental schools have reassessed and updated pain management curricula and clinical protocols to further ensure their graduates are competent and safe prescribers. Changes include using alternative methods for pain management, such as nonsteroidal anti-inflammatory drugs (NSAIDs), and recognizing the symptoms of addiction and substance misuse problems” .
Educating the public is critical, and equally important is educating future dental prescribers. As stated in the ADEA executive summary, efforts are being made within dental educational institutions to curb the trends seen in the research data. Updated Commission on Accreditation (CODA) standards require that students must be competent in “pain and anxiety control, including consideration of the impact of prescribing practices and substance use disorder”. These measures are addressed in didactic courses as well as during clinical training. The University of Illinois at Chicago (UIC) College of Dentistry is introducing Opioid Risk Tools during assessment of patients prior to Oral Surgical procedures in order to ensure evidence based decision making relative to prescribing pain medication. The College of Dentistry is also in collaboration with a number of UIC Health Science Colleges to develop opioid training modules for the post graduate specialty and residency programs. Such measures in dental educational settings will impact the clinical practice of future dentists, and it is expected that the tide will continue to turn toward safer pain management approaches.
There are no disclosures. The study was funded by the Agency for Healthcare Research and Quality (AHRQ).
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