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Letters: Dentistry and medicine

March 04, 2019

Drs. Craig S. Miller, Nelson L. Rhodus and John C. Robinson make several very important points in their Nov. 19 My View "Does Dentistry Have a Role in Health Care?" The interprofessional relationship between dentistry and medicine is particularly important when dealing with the potential for opioid misuse. Dentists may be faced with patients who require opioid medications for pain relief and who may be at risk for misuse of these prescriptions. Under these circumstances a discussion with the patient's primary care team, neurologist or pain specialist is mandatory in providing safe and effective pain management. Many dentists are not trained in risk assessment nor the management of these situations, and many still feel that it is not within their scope of practice to provide these critical services. We feel that this is a lost opportunity to provide the best clinical care, develop relationships with our medical colleagues and help, albeit in a small way, curb the prescription opioid epidemic.

The suggestions the authors offered could be better realized by enhancing interprofessional education at the level of predoctoral dental school education. Rather than simply providing didactic lectures on substance use risk, true interprofessional training should involve collaboration on complex cases where each discipline can provide critical input within their expertise. For example, we are now fortunate to have joint programs in Massachusetts where dental, medical, pharmacy and nursing students review complex cases and receive education on opioid overdose reversal with naloxone as part of this training. The three Massachusetts dental schools have partnered together with the Massachusetts Dental Society and the Commonwealth of Massachusetts Department of Public Health in promoting undergraduate education in risk assessment, interprofessional communication and effective pain management as well as providing a variety of continuing education offerings for practicing dentists. In this way dentists can become a more integrated part of the health care system.

David Keith, D.M.D.
Ronald Kulich, Ph.D. 
Boston