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University of Pittsburgh School of Dental Medicine adopts opioid-free prescribing guidelines

November 13, 2019

By Mary Beth Versaci

Pittsburgh –– The University of Pittsburgh School of Dental Medicine is helping to combat the opioid crisis by becoming the first institution of its kind to establish a set of opioid-free pain management guidelines for a majority of outpatient procedures performed in its dental clinics, the school announced Nov. 6.

The goal of the guidelines is to reduce opioid prescribing and abuse by emphasizing nonnarcotics, such as ibuprofen or acetaminophen, as the first choice to manage pain.

Mr. Costello
Dr. Costello
"That really should help us provide a lower risk for our communities and make sure that this type of thing is changed over time so that the addiction rates hopefully go down and our communities aren't ravaged by this like they have been," said Dr. Bernard J. Costello, dean of the dental school. "It's going to take a while to have this spread within the field. These are the types of changes that we want to see happen in health care."

While the opioid crisis has affected communities across the United States, the Appalachian region has been hit especially hard. The Pennsylvania Attorney General's Office estimates 12 Pennsylvanians die from an opioid, heroin or fentanyl overdose every day.

"We're representative of the other hot zones in the United States," Dr. Costello said. "The Appalachian corridor has been ravaged by this."

In 2017, prescription opioids were involved in more than 35% of opioid overdose deaths in the United States, according to the Centers for Disease Control and Prevention. Taking prescription opioids for longer periods of time or in higher dosages can increase the risk of addiction, overdose and death.

Most outpatient procedures do not require opioids for optimal pain management, but there could be specific clinical circumstances where opioid medications may be among the appropriate treatment options. The guidelines can help dentists account for these situations as they make individual assessments, Dr. Costello said.

"It's not a cookbook approach to take care of patients; it's guidance that helps clinicians make a good choice based on what they know of the biology of the patient and the patient's concerns," he said.

The guidelines are not only for dentists practicing in the dental school's clinics but also for dental students and residents as they learn how to approach pain management for their future patients.

"That's a huge part of it, really," Dr. Costello said.

Building on earlier policy indicating that dentists should consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain, the American Dental Association adopted a policy on opioids in 2018 that supports prescription limits and mandatory continuing education for dentists. The policy is believed to be one of the first of its kind from a major professional health organization.

In addition to its opioid policy, the ADA continues to raise professional awareness about prescription opioid abuse, encouraging dentists to complete Continuing Education Provider Recognition training in model opioid prescribing and urging them to register with their state prescription drug-monitoring programs. The ADA regularly offers free online webinars on safe and effective opioid prescribing for dental pain.

The ADA Practical Guide to Substance Use Disorders and Safe Prescribing also assists dental practitioners with identifying and treating patients with drug addiction, preventing drug diversion and properly managing and prescribing controlled substances.

For more information on how the ADA is working to combat opioid abuse, visit