Arizona is among six states that have declared the opioid epidemic a public health emergency—and for good reason. According to the Arizona Department of Health Services, at least 790 Arizonans died from opioid overdoses in 2016, an increase of 16% from the previous year and a 74% increase since 2012.
Like physicians, nurse practitioners, psychiatrists, or any number of professionals who prescribe medications, dentists can play a prominent role in preventing opioid misuse. Oftentimes, people are first exposed to opioids when they undergo a routine oral surgery, like getting their wisdom teeth removed. This puts the dental community in a unique quandary. How do we balance the appropriate management of pain with safe prescribing practices and at-home use of prescribed medications?
It is our job as dental professionals and healthcare leaders to look within and address the root causes of the epidemic. Postoperative pain management following oral surgery frequently requires a prescription for pain medication. And while it is our responsibility to manage our patients’ pain, it is also our responsibility to seek the safest options.
For example, studies reveal that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are more effective than opioids in relieving postoperative dental pain with fewer side effects and less potential for abuse. In the absence of medical contraindications such as reduced kidney function and bleeding concerns, prescription NSAIDs should be our frontline approach to managing postoperative dental pain. If opioids prove to be necessary for the occasional dental patient, we should be careful to prescribe the lowest possible effective dosage for as short a period as possible.
The Arizona State Board of Dental Examiners mandates continuing education for dentists on the topic of substance abuse, which is a good starting point for mitigating the dental component of the opioid epidemic in Arizona. To minimize abuse, we must be diligent in conducting a thorough medical and dental history, including documentation of current medications taken before prescribing opioids and cross-referencing the Controlled Substances Prescription Monitoring Program.
The bottom line? Dentists and all healthcare professionals should heed this as a call to return to basics. Take the time to talk to patients. Alert them to the risks and complications of any medications they are prescribed. Recommend treatment options that utilize best practices to prevent exacerbation of or relapse of opioid misuse. Instruct them on responsible storage and disposal of prescription opioids to avoid misuse and abuse.
That last piece is especially important, given the mounting evidence showing that individuals who abuse prescription opioids often get them from friends or family members. In fact, a 2016 study by researchers at the University of Pennsylvania found that 100 million opioid pills prescribed for wisdom tooth extraction go unused each year, leaving the door open for possible abuse or misuse by patients, their friends, or their family. The same study also found that informing patients of drug disposal programs boosted proper disposal of leftover pills by 22%.
Close your eyes and think about what 790 people looks like in your life. It may be the number of people with whom you graduated from high school. Or your congregation at church. Maybe it’s half of the players in the National Football League. No matter how you visualize these individuals, one thing is certain. This is an alarming number of humans to lose each year because of opioid overdose. We have a duty to act to prevent opioid misuse and, if we do so, we might save countless lives in the process.
Dr. Harvey is the Delta Dental of Arizona board chair and a practicing periodontist in Tucson. He holds a DDS as well as a master of science degree and certificate in periodontics from the University of Iowa. He also has held numerous leadership positions in the Arizona Dental Association, serving as president in 2001 and as editor of its journal from 2004 to 2008. And, he is involved with the Arizona Dental Foundation, serving as a board member from 1988 to 2011. He can be reached at marketing@deltadentalaz.com.
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