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Amid opioid epidemic, training helps dentists safely manage patient pain

Nearly 400 dental professionals nationwide have participated in OHSU School of Dentistry-organized series
OHSU's Gianncarlo Cruz, DDS, consults a patient on a safe level of pain management on Tuesday, Nov. 1, 2022, at the OHSU School of Dentistry in Portland. (OHSU/Christine Torres Hicks)
OHSU dental resident Gianncarlo Cruz, D.D.S., demonstrates how dental professionals discuss safe pain management with patients on Tuesday, Nov. 1, 2022, at the OHSU School of Dentistry in Portland. (OHSU/Christine Torres Hicks)

Knowing the removal of wisdom teeth and other dental surgeries can involve powerful prescription painkillers, Oregon Health & Science University is helping dental professionals take steps to be responsible prescribers — an important effort in addressing the national opioid epidemic.

Richie Kohli, B.D.S., M.S. stands in a hallway at OHSU School of Dentistry.
Richie Kohli, B.D.S., M.S. (OHSU)

“Because many who misuse opioids obtain prescription pills from family and friends, it’s important for dentists to discuss with patients how to securely store opioids and how to dispose of them when they’re no longer needed,” said Richie Kohli, B.D.S., M.S., associate professor in the OHSU School of Dentistry’s Division of Dental Public Health.

Since 2019, OHSU School of Dentistry faculty have organized 10 iterations of an interactive, web-based training series called Pain Management and Substance Abuse Disorder in Dental Settings. The training aims to help dentists, dental hygienists and others involved in oral health care to better understand the complex issues associated with substance use disorder and how the dental field can help address it.

Karan Replogle, D.D.S., M.S. at OHSU School of Dentistry
Karan Replogle, D.D.S., M.S. (OHSU)

“Our goal is to help dentists be respectful prescribers who are informed of best practices,” said Karan Replogle, D.D.S., M.S., senior associate dean for clinical systems in the OHSU School of Dentistry. “For example, over-the-counter medications such as ibuprofen, acetaminophen or a combination of the two can relieve most dental pain more effectively than opioids. When opioids are recommended for severe pain, they’re rarely needed for more than three days.”

According to the National Institute of Dental and Craniofacial Research, about 75% of opioid abusers are believed to have been introduced to the drug through a prescription. In 2012, more than half of 14- to 17-year-olds received opioid prescriptions from dentists following wisdom tooth extractions. Dentists were the third-most-frequent prescribers of opioid pain medications in 2010.

After the U.S. government declared a public health emergency related to the nation’s opioid epidemic in 2017, awareness of potential opioid prescription abuse grew, and dentists began changing how they manage their patients’ pain. The OHSU School of Dentistry training seeks to help oral health care professionals do just that.

Replogle and Kohli are the lead organizers of the training series, which has been funded by the Oregon Health Authority and the U.S. Substance Abuse and Mental Health Services Administration. To date, 388 people involved in dental care — from 40 U.S. states and two Canadian provinces — have participated.

Over the course of seven weeks, the virtual series covers a variety of topics:

  • 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.

In September, OHSU School of Dentistry faculty published a paper in the journal BMC Oral Health that showed the training is improving participants’ understanding of pain medications, substance use disorder, state Prescription Drug Monitoring Programs and more.

Held in collaboration with the Oregon ECHO Network at OHSU, the virtual, live video training uses the ECHO model, which features a mix of presentations by experts and discussions among participants about how to apply the information they’re learning to real-world examples in dental clinics. While this effective educational approach has been used for medicine for years, this series is believed to be the first time ECHO has been used for dentistry.

Training facilitators have included dental experts, addiction and emergency medicine physicians, a pharmacist, a social worker and a patient in recovery from substance use disorder. In addition to Replogle and Kohli, other OHSU faculty involved in the training series include: Barry Taylor, D.M.D. FAGD; Harjit Sehgal, B.D.S., M.S.; Brandon Maughan, M.D.; Rosemarie Hemmings, Ph.D.; and, Megan Herink, Pharm.D. Also involved is Andrea Gough-Goldman, M.D., M.P.H., of CODA, Inc.

The Pain Management and Substance Abuse Disorder in Dental Settings training’s next series will begin Jan. 4, 2023. More information is available online. Advanced registration is required.

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