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April JADA examines opioids and dentistry

March 26, 2018

By Jennifer Garvin

The April issue of The Journal of the American Dental Association focuses on the subject of opioids and dentistry.

The four cover articles look at:

In the article "Opioid Prescribing Practices from 2010 through 2015 Among Dentists in the United States: What Do Claims Data Tell Us?" authors from the ADA Health Policy Institute reviewed opioid prescriptions by dentists per 1,000 privately-insured dental patients up to age 64 from 2010 through 2015. They found that from 2010-15, the median number of days' supply of opioids prescribed by dentists was three days. They also found that, across all age groups over the six-year period, opioid prescriptions increased by 17 per 1,000 dental patients.

In the article "Sex and Race or Ethnicity Disparities in Opioid Prescriptions for Dental Diagnoses Among Patients Receiving Medicaid," authors from the U.S. National Library of Medicine, National Institute of Dental and Craniofacial Research and the DentaQuest Institute looked at specific factors, including sex, race and ethnicity, and health care provider, in more than 890,000 Medicaid patients who received opioid prescription after a dental diagnosis.

They found that emergency departments prescribed opioid medications almost five times more often than dentists, and nurse practitioners prescribed opioids nearly three times as often compared to dentists. They also found that female patients were 50 percent more likely to receive an opioid for pain management of a dental condition during an emergency department visit than male patients.

In the article "Benefits and Harms Associated With Analgesic Medications Used in the Management of Acute Dental Pain: An Overview of Systematic Reviews," authors from the University of Pittsburgh School of Dental Medicine, Case Western Reserve University School of Dental Medicine, The Ohio State University and the ADA reviewed the best available evidence with respect to questions of safety and efficacy for relief of acute pain relevant in dentistry.

The authors looked at five systematic reviews that explored the effectiveness and/or adverse events associated with acute pain relief from opioids and nonsteroidal anti-inflammatory drugs in adults and children. They found that for adults, a combination of 400 mg of ibuprofen and 1,000 mg of acetaminophen was superior to any opioid-containing medications studied. They also found that opioids or drug combinations that included opioids accounted for the most adverse events — such as drowsiness, respiratory depression, nausea, vomiting and constipation — in both children and adults.

"The best available data suggested that the use of nonsteroidal medications, with or without acetaminophen, offered the most favorable balance between benefits and harms, optimizing efficacy while minimizing acute adverse events," the authors concluded.

Finally, in the article, "Prescription Monitoring Program Data: What It Can Tell You," the authors — professors from the Harvard School of Dental Medicine and Tufts University School of Dental Medicine and a retired Massachusetts State Police detective lieutenant — shared 10 clinical scenarios taken from the Massachusetts Prescription Awareness Tool to illustrate ways some dentists could potentially encounter patients attempting to misuse opioids. In one scenario, the authors described a 55-year-old woman with a history of temporomandibular joint pain and prescription drug misuse who was evaluated for a recurrence of facial pain. In looking up her data on the state's prescription monitoring program database, providers in the scenario were able to see that in the past year the patient had received 151 prescriptions, 97 of which were opioids. They also discovered the patient was registered under two different names and had two addresses. Upon discovery of this information, the providers had a discussion with the patient, which resulted in a referral to substance use disorder treatment program.

In another clinical scenario, a 17-year-old girl had a cyst removed from the right maxilla and was given a five-day supply of liquid oxycodone by her dental surgeon. Three days later, the child's mother called her primary care physician who prescribed 24 tablets of 5 mg oxycodone. The mother then called the dental surgeon and requested Percocet. The mother was told her daughter had actually been prescribed oxycodone and when asked how many pills were left, "became hostile, yelled and did not provide the answer." During a discussion of how to handle this type of scenario, it was determined that there was a need "for an opioid therapy treatment agreement with both the patient and mother and a discussion with the primary care physician."

To read the articles, visit JADA.ADA.org.