35
Volume2 Issue2
|
S
upporting
Y
our
P
ractice
In late 2013, a focus groupmet to participate in theOrofacial PainTeam
Workshop, held inMontreal,Canada, where the issueof appropriateopioid
analgesicprescribing forpainbyCanadiandentistswasdiscussed.Therewas
agreement that the use of opioid analgesics by dentists for either acute or
chronic orofacial pain conditions has not been investigated satisfactorily in
thiscountry.
Anumber of questions related to theuseof opioidanalgesicsbydentistswere raisedby
the focusgroup: Howwell dodentistsmanagepost-operativepain?Howoftendopatients
report inadequateanalgesiaafter dental surgery?Howoftenareopioidanalgesicsprescribed
and forwhichprocedures?Dodentistsoverprescribe?Do they instruct their patients about
the risks related to leftover doses?Dodentistsmonitor theuseof opioidanalgesicsby their
patients and, if so, howdoesmonitoringvary inurbancompared to rural areas? Isopioiduse
different inunderservedpopulations?What are the risk factors for problematicuse?What is
thecurrent level of knowledgeabout theuseof opioidanalgesics inpopulations thought to
bemorevulnerable tomisuseor abuse?
Opioid analgesicprescribing for acutedental pain
Theexisting literature suggests that theuseof opioidanalgesics for acuteprocedural pain
varies significantly indifferent countries. In theUK in2001, of all prescriptions for analgesics
writtenbydentists, themost commonlyprescribedanalgesicwas ibuprofen, representing
73%of prescriptions. Theonlycommonlyprescribedopioidanalgesicwas codeine,which
representedonly19%of prescriptions.
1
Oneof themost studiedacute surgical procedures
indentistry is thirdmolar extraction.Meta-analyses indicate thatNSAIDs, like ibuprofen, show
thebest evidence for efficacy for painpost-extraction (roughly80%of patientsgiven600mg
ibuprofenhad>50%pain relief), consistentwith theuseof ibuprofenbyUKdentists.
1,2
Useof
codeine (60mg)withacetaminophen (650mg) is less likely toproduce significant pain relief
post-extraction, and is associatedwithamuchgreater incidenceof adverseeffects.
1
Incontrast to themodest prescribing rateof opioidanalgesicsbyUKdentists, in theUS,
12%of all immediate releaseopioidanalgesicprescriptions arewrittenbydentists (just
slightly less than familyphysicians).
3
AnAmericanDental Association survey from2006
suggested thatwhileamajorityof oral andmaxillofacial surgeons (74%) preferredpatients
touse ibuprofenafter thirdmolar extraction, 85%alsoprescribedanopioidanalgesicpost-
procedure (most commonlyhydrocodoneor oxycodone).
3
Prescribingpatterns after oral
surgical or endodontic treatments at adental clinicat theUniversityof Alabama indicated
about 80%of patients receivedaprescription for anopioidanalgesic (most commonly
THEAUTHORS
BrianE.Cairns
PhD,ACPR
ArletteKolta
PhD
EliWhitney
DDS,FRCD(C)
KenCraig
PhD
NathalieRei
DMD,MSD,Cert.
médecinebuccale
DavidK.Lam
MD,DDS,PhD,
FRCD(C),DABOMS
MaryLynch
MD,FRCPC
BarrySessle
MDS,PhD,DSc(hc)
GillesLavigne
DMD,MSc,PhD
Dr. Cairns andKolta
werepart of a
CE sessiononopioids
and themanagement
of orofacial pain
at thePacificDental
Conference in
March2015.
