CDA Essentials 2017 • Volume 4 • Issue 7

19 Issue 7 | 2017 | I ssues and P eople Dr.Mark Donaldson Why is the opioid crisis relevant to dentistry? It’s a significant issue not only in dentistry but also in medicine. In dentistry, we still have a number of practitioners who prescribe opioids for postoperative dental pain (p. 21). Although many patients may not complain about that practice, the underlying pathophysiology of dental pain is secondary to inflammation. So we should be using anti-inflammatory agents to target dental pain; narcotics are not anti-inflammatory agents. By curtailing or avoiding the prescription of opioids—certainly if opioids are not specifically indicated—that will limit the supply and therefore take away opportunities for the public to get caught up in the use, misuse and potentially abuse of these controlled substances. How bad is the problem? According to the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics, the drug-poisoning death rate in the U.S. more than doubled between 2000 and 2014, and poisoning by drugs—both illicit and pharmaceutical—have now surpassed car accidents as the leading cause of accidental deaths in the U.S. I would argue that Canada is not immune to these trends, given the recent publication by Gladstone et al., 1 which concluded that, “the number of pharmaceutical opioid-related deaths exceeds the number of deaths from motor vehicle accidents involving alcohol in B.C.” Many of us, certainly in dentistry, are looking to get our patients out of pain, and opioids can work to a certain extent, but because they target the central nervous system rather than the local area where the pain originates, people will still have untreated pain–they just care less about it. I also don’t think all of us appreciate the side effects, adverse effects, or collateral damage from a 2–5 day course of narcotics that we prescribe to our patients. What treatment do you recommend for postoperative dental pain—other than opioids? There are a few strategies to consider: ➊  2-4-24: I believe the best postoperative dental analgesic recipe is a combination of acetaminophen, like Tylenol, and a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (brand names include Advil and Motrin). I often teach the mnemonic “2-4-24,” Dr. Mark Donaldson is senior executive director of pharmacy advisory solutions at Vizient Inc., a national health care network of not-for-profit hospitals in the United States. He has a doctorate in clinical pharmacy from the University of Washington and a special interest in dental pharmacology and dental therapeutics. He spoke with CDA about the significance of the opioid crisis for dentistry and how to treat postoperative dental pain without opioids. Theviewsexpressedarethoseof theauthoranddonotnecessarily reflecttheopinionsorofficial policiesoftheCanadianDental Association. mark.donaldson