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4 Reasons Why (Dental) – Brochure

Panel 1:

References:

  1. Moore PA, Ziegler KM, Lipman RD, et al. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. J. Am. Dent. Assoc. 2018;149(4):256-65.
  2. Maughan BC, Hersh EV, Shofer FS, et al. Unused opioid analgesics and drug disposal following outpatient dental surgery: a randomized controlled trial. Drug and alcohol dependence. 2016;168:328-34.
  3. Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg. 2018;153(3):285-287.
  4. Nalliah RP, Sloss KR, Kenney BC, et al. Association of Opioid Use With Pain and Satisfaction After Dental Extraction. JAMA Netw Open. 2020;3(3):e200901. doi:10.1001/jamanetworkopen.2020.0901
  5. Lee JS, Hu HM, Brummett CM, et al. Postoperative opioid prescribing and the pain scores on hospital consumer assessment of healthcare providers and systems survey. JAMA Surg. 2017;317(19):2013-2015.
  6. Schroeder AR, Dehghan M, Newman TB, et al. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA internal medicine. 2019;179(2):145-52.
  7. Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM. Persistent opioid use after wisdom tooth extraction. JAMA. 2018;320(5):504-6.
  8. Brummett CM, Waljee JF, Goesling J, Moser S, Lin Pl, Englesbe MJ, Bohnert ASB, Kheterpal S, Nallamothu BK. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. DOI: 10.1001/jamasurg.2017.0504
  9. Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future National Survey Results on Drug Use, 1975–2015. Ann Arbor, MI: The University of Michigan; 2016
  10. Sekhri S, Arora NS, Cottrell H, et all. Probability of opioid prescription refilling after surgery: Does initial prescription dose matter? Ann Surg. 2018;268(2):271-276.
  11. Oral Analgesics for Acute Dental Pain. (n.d.). Retrieved July 30, 2020, from https://www.ada.org/en/member-center/oral-health-topics/oral-analgesics-for-acute-dental-pain

Panel 2:

The evidence shows:

  • 6.9% of adolescents & young adults receiving dental opioids become new persistent opioid users. (often their first exposure to opioids) (reference 7)
  • In comparison to opioids, over-the-counter NSAIDS and acetaminophen proved as effective at acute dental pain
    management with less risk. (ADA: use NSAIDS as the first line therapy) (reference 1)
  • In outpatient dental surgery, 54% of prescribed opioids go unused. (reference 2)
  • No correlation between probability of refill or patient satisfaction scores and amount of opioids prescribed

Panel 3:

Becoming a new chronic opioid user is one of the most common surgical complications.

  • In adolescents and young adults who received dental opioids, 6.9% went on to become new persistent opioid users and 5.8% had an opioid abuse or overdose related encounter. (reference 6)
  • Filling an opioid after wisdom tooth removal resulted in more than three times the risk of becoming a new persistent opioid user. (reference 7)
  • Many patients continue to use their opioids for reasons other than surgical pain. (reference 8)
  • New persistent opioid use after surgery is an underappreciated surgical complication that warrants increased attention. (reference 8)
  • Most adolescents believe that prescription opioids are safer than other substances of abuse. (reference 9)

 

Acetaminophen and ibuprofen are as effective as opioids in managing pain.

  • A combination of ibuprofen and acetaminophen is more effective at dental pain control than combinations with opioid medications and this combination carries less risk of adverse events. (reference 1)
  • In outpatient dental surgery, 54% of prescribed opioids go unused. (reference 2)
  • Patients who were prescribed fewer opioids reported using fewer opioids with no change in pain scores. (reference 3)

 

Opioids do not improve patient satisfaction.

  • Patients who used opioids for pain management after tooth extractions reported significantly higher levels of pain as compared to non-users. (reference 4)
  • Dental patients’ satisfaction scores did not change between pain management opioid users and nonusers. (reference 4)
  • No correlation was found between HCAHPS pain measures and postoperative opioid prescribing. (reference 5)
  • Prescribers can feel empowered to reduce their initial opioid prescription without impacting patient satisfaction. (reference 5)
  • Prescribers could prescribe smaller opioid prescriptions without influencing the probability of a refill request. (reference 10)
  • Implementation of evidence-based prescribing guidelines reduced postlaparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills. (reference 3)

 

These prescribing recommendations, developed by Michigan OPEN for patients with no preoperative opioid use*, were informed by patient-reported data from our Collaborative Quality Initiative (CQI) partners, published studies and expert opinion.

Click to view our Prescribing Recommendations, and even download them in PDF form. You can also sign up for notifications of updated recommendations and additional procedures.

*No opioid use in the year prior to surgery.


Panel 3:

Counseling patients about pain & opioid use after surgery:

  • Set pain expectations in relation to procedure
  • Focus on post-operative functional goals. Ability to:
    • eat
    • move
    • breathe deeply
    • sleep
  • Focus on non-opioid pain management alternatives
    • NSAIDs, acetaminophen
    • physical therapy
    • acupressure
    • meditation/mindful breathing
  • Discuss appropriate use
    • only for acute surgical pain
  • Discuss adverse effects
    • nausea, vomiting, constipation
    • risk of dependence
    • addiction
    • potential overdose
    • diversion
  • Educate on safe storage and disposal

Michigan OPEN is partially funded by the Michigan Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and National Institute on Drug Abuse.

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