Problems with pain are popping up in procedures and dentists are being trained on how to properly manage that pain.
Through a training program at Oregon Health & Science University, hundreds of dental professionals nationwide are learning how to better understand issues with substance use disorder and how they can be addressed.
It comes as opioid addiction is driving up the death toll nationwide. More than 107,000 Americans died of drug overdoses in 2021, setting another tragic record in the nation's escalating substance abuse epidemic. Data from the Centers for Disease Control and Prevention translates this to roughly one overdose death every 5 minutes in the U.S. It marks a 15% increase from the previous record, set only the year before.
U.S. overdose deaths have risen most years for more than two decades. The increase began in the 1990s with overdoses involving opioid painkillers, followed by waves of deaths led by other opioids like heroin and — most recently — illicit fentanyl.
Experts from the National Institutes of Health estimate that 75 percent of opioid abusers were introduced to opioids through prescription drugs. It’s also estimated that more than half of 14- to 17-year-olds receive opioid prescriptions for acute dental pain following wisdom tooth extractions. The research showed that, in 2010, dentists were the third-most-frequent prescribers of opioid pain medications.
The OHSU School of Dentistry team is teaching some safe steps dental professionals can take to help fight substance abuse.
Dr. Karan Replogle and Dr. Richie Kohli told KATU that the web-based training series called Pain Management and Substance Abuse Disorder in Dental Settings was born out of a personal pain connection.
Replogle said she saw a colleague mourning the loss of a son "who was unable to successfully move through a substance abuse program." The addiction started with opioids after a dental appointment, she said.
"[What] struck me was the fact that I needed to be part of the solution - to be able to educate dentists about the risk of overprescribing," said Replogle, the senior associate dean for clinical systems in the OHSU School of Dentistry.
The national problem with opioid prescription peaked in 2012. That's when healthcare providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the U.S. to have a bottle of pills.
Since then, federal and state governments have worked to curb the crisis. For example, Oregon uses the Prescription Drug Monitoring Program (PDMP) to keep track of proper and safe prescribing.
"I am able to look up and see, for any patient I am taking care of, their history related to opioid prescribing. It allows me to be informed, it allows me to be compassionate, and it allows me to have a conversation with any patient about their pain, how they're currently managing pain, and how that may affect any pain medication that I need to prescribe to them as a dentist for a dental procedure," Replogle said when asked how the PDMP has changed her dental practices.
The Pain Management and Substance Abuse Disorder in Dental Settings training’s next series will start on Jan. 4, 2023, and OHSU is still accepting advanced registration, which is required.
Replogle and Kohli are the lead organizers of the training series. OHSU staff said that, to date, 388 people involved in dental care from 40 states and two Canadian provinces have participated. The seven-week training course covers several topics, including:
- Helping patients understand what level of pain to expect before beginning a procedure.
- When less-addictive painkillers, such as acetaminophen or non-steroidal anti-inflammatories, are effective for pain management.
- What current research and guidelines recommend, and what state and federal laws require, for opioid prescriptions.
- How dentists should use their state’s Prescription Drug Monitoring Program to check how frequently their patients have received opioid prescriptions from other providers.
- What substance use disorder is and how to identify it in patients.
- How dentists can help patients with substance use disorder manage pain in collaboration with their health care providers.
- How unconscious biases can affect prescribing and other pain management practices.
"The questions you get most often from a patient are how much am I going to be in pain? What is my pain level going to be? And how are you going to help me manage this discomfort that I may have after the dental procedure?" Replogle explained.
The sessions include lessons on how to help patients manage their pain expectations before starting the procedure.
"Previously, the norm has been that you would be pain-free. That has some historical background about how the dentists or the healthcare providers were overprescribing," said Kohli, an associate professor in the OHSU School of Dentistry’s Division of Dental Public Health.
The team also wants to help people identify a substance use disorder, including ways to properly dispose of pain pills and how to keep them out of the wrong hands when you're all done using them.
"So [the medication] doesn't get misused and then ends up with addiction, overdose, and sadly death in some situations," Kohli said.