While there is much discussion about the opioid crisis, you may not immediately think of dentistry. Yet in the 1990s, dentists were the top clinical prescribers of opioids. With a number of innovative and educational initiatives, prescriptions ordered by dentists dropped more than 50 percent by 2012, according to the Journal of the American Dental Association.
There can be lessons learned by dentists and also physicians and other medical care practitioners. Dentists themselves say they are working to continually improve their oversight of opioid prescriptions to reduce opioid misuse and abuse.
For years, dentists have prescribed opioids, but are routinely making limits on such prescriptions. They prescribe the opioids for different reasons: such as controlling acute pain following dental procedures, including when tooth are extracted, where dental implants are placed. Periodontal and endodontic surgeries are also included, according to Dr. Martha Somerman, director of the National Institute of Dental and Cranofacial Research, Journal of the American Dental Association, and Nora Volkow, director of the National Institutes of Drug Abuse.
Whether it’s prescribed from dentists or physicians, routine use of opioids has resulted in much dependence among American patients, and misuses sparked by such dependence. The results have been catastrophic, what the Trump Administration has called a public health emergency in America.
When dentists were considered the top specialty prescribers of immediate-release opioids, they accounted for more than 15 percent of all immediate-release opioid prescriptions. Immediate-release opioids are usually conventional drugs, such as tablets and capsules, taken orally or by the mouth. By the 2000s, dentists prescribed fewer opioids in relation to other medical professionals. In 2009, dentists represented 8 percent of immediate-release opioid prescriptions, but that amount dropped to 6.4 percent.
Opioids are also prescribed in emergency departments (EDs) to manage dental pain until treatment can be started.
Dentists Make Prescription Changes
Over the years, however, dentists used alternative approaches toward treating pain, following plans initiated by the American Dental Association, and the rate of opioid prescriptions that dentists ordered dropped “considerably.”
The American Dental Association launched a new policy earlier this year to reduce the misuse of opioids and to “keep prescription opioids from harming dental patients and their families.”
Among other things, the policy establishes prescribing limits on opioid dosages, such as no longer than 7 days for treatment of chronic pain. The policy also advises mandatory continuing education on prescribing opioids and other controlled substances. Dentists are developing educational interventions to encourage what is known as “risk mitigation strategies,” such as registering with and using Prescription Drug Monitoring Programs before prescribing opioids for pain management.
Prescription Drug Monitoring Programs are electronic databases that track controlled substance prescriptions in a state. As such they can provide health authorities timely information about prescribing and patient behaviors that contribute to the epidemic and facilitate a nimble and targeted response, according to the Centers for Disease Control and Prevention.
Experts say that more must be done, however. Some of the problems involve general physicians and nurses who treat dental pain. For instance, emergency department physicians often prescribe opioid and other analgesic medications to manage acute dental pain. Indeed, “an examination of a nationally representative data set suggested no reduction in the rate of opioid analgesic prescriptions for dental pain in emergency settings,” according to the studies.
The reports noted that a separate study of Medicaid recipients found that patients having a dental condition were almost three times as likely to receive an opioid from a nurse practitioner as a dentist.
More Research Necessary
To better understand dentists’ opioid prescribing practices, the National Institutes of Dental and Craniofacial Research (NIDCR) is using the National Dental Practice-Based Research Network. The Network includes than 6,000 dental practitioners who regularly see patients and seek to conduct research on their work.
The network seeks to develop tools to improve clinical-decision making related to alternatives among other plans.
“Dentists play a key role in addressing the opioid crisis,” researchers said. “(American Dental Association’s) new opioid policy has the potential to lead to further reductions in opioid prescribing for acute dental pain and may serve as a model for other clinical professions.”
The ADA says it is partnering with the National Institutes of Health “that underscores the importance of scientific evidence to guide clinical decision- making and helps ensure that dental practitioners are kept abreast of the latest research.” – Joe Cantlupe, HealthDataBuzz
Centers for Disease Control and Prevention. Opioid overdose. 2018. National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. https://www.cdc.gov/drugoverdose/index.html.
Ibid. What States Need to Know about PDMPs. 2017. Retrieved from: https://www.cdc.gov/drugoverdose/pdmp/states.html
Dr. Martha Somerman, director of the National Institute of Dental and Craniofacial Research, Journal of the American Dental Association, and Nora Volkow, director of the National Institute of Drug Abuse. The Role of the Oral Health Community in Addressing the Opioid Overdose Epidemic. Retrieved from: https://jada.ada.org/article/S0002-8177(18)30419-7/fulltext and
Dr. Nora Volkow. National Institutes of Health blog: NIH Partners with the Dental Community to Help Curb the Opioid Crisis.
Miriam Valverde, Donald Trump declares public health emergency over opioid crisis. Here’s what that means. 2017. Politifact. Retrieved from: https://www.politifact.com/truth-o-meter/article/2017/oct/30/opioid-epidemic-united-states-and-trump-administra/