31
Volume3 Issue3
|
I
ssues and
P
eople
Dr. DavidMock, chair of theRCDSO'sQualityAssuranceCommittee, alsochaired theworking
group that developed theGuidelines. “Theguidelinesweredeveloped in response to
thegrowingconcernof healthproviders, healthagencies andgovernments at all levels
regarding theescalating societal problemsof opioidabuse,while still ensuringadequateand
appropriatepainmanagement indentistry,” saysDr.Mock. “Substanceabuseof prescription
drugs likeopioidshas adevastating impact on individuals and their families, andplaces a
significant burdenonhealthcare inCanada.”
TheRCDSOguidelines include:
❚
Bestpractices foropioiduse in themanagementof acutepain
. This includes advice
for treatingpatientswho returnwithongoingor unmanagedpain. Each timeapatient
returns, thedentist should reasess theaccuracyof thediagnosis and/or sourceof the
patient’spainandalways consider appropriatenon-phramacologicmanagement.
“Only inaminorityof situations is anopioid required.”
❚
Bestpractices foropioiduse in themanagementof chronicpain
, either primarilyof
oral-facial origin (e.g., temporomandibular disorders andneuropathic/neuralgicpain) or
not primarilyof oral-facial origin (e.g., tension-typeheadacheswith facial pain,migraines).
Consultationandcollaborationwithother healthpractitioners (possibly including the
pharmacist, familyphysician, nursepractitioners, ormedical/dental specialist) isusually
advisable, particularly if thedentist isnot experiencedor comfortablewith thedrugs
involved in theappropriatepharamcotherapy.
“Unlikeacute pain, pharmacologicmanagement of chronic temporomandibu-
larpain implies long-termuse,whichmay result indrug tolerance, escalating
dosageand increased risks of adverse effects.Opioids are rarely indicated.”
❚
Assessing risk, detectingproblematicuseandmanaging thehigh-riskpatient.
“Before prescribingopioids, thedentist should ensure the patient’s expectations
are realistic.The goal of analgesic therapy is rarely the eliminationof pain, but
rather the reductionof pain intensity.”
❚
Practical considerationsonprescriptions
, includingwhat information to include, ensuring
clarityofwrittenandverbal prescriptions, and securely issuingwrittenprescriptions.
“Dentists shouldbeaware that pharmacists are responsible for confirming the
authenticityof eachprescription,whichmay requiredirect confirmationwith
the prescriberbefore the prescription is filled.”
a
NewGuidance forOntarioDentists
on role of opioids in acute and chronic painmanagement
InNovember2015, theRoyalCollege ofDental Surgeons ofOntario (RCDSO)published
TheRoleofOpioids in the
ManagementofAcuteandChronicPain inDentalPractice.
Ashealthproviders and thepublicbecomeaware of the
alarming increase indeathsdue toopioidoverdose, the guidelines canhelpdentists prevent themisuse, abuseand/ordiversionof
opioids that can resultfromoverprescribing.
Dr.DavidMock
TheRCDSOguidelines are
availableonline through
theRCDSOLibraryunder
Professional Practice
(Advisories, Standards,
Guidelines)
at
rcdso.org
