In the era of an opioid crisis: Now what?

Abstract

I have recently been reviewing the changes in guidelines for opioid prescribing among dentists and been pleasantly surprised that the opioid prescriptions have been substantially reduced since the Centers for Disease Control and Prevention (CDC) reviewed the data from 2021 in their updated 2022 Clinical Practice Guideline for Prescribing Opioids [1]. In the recent February issue of JADA [2], Heron et al. conducted a national survey of dentists and reported that the increased use of Prescription Monitoring Programs in individual states has further helped, but the opioid use is still at higher than needed levels in dentistry. In chronic pain circles, the use of opioids is now frowned upon among pain doctors and orofacial pain dentists; however, the larger dentist community still is persuaded by their patients to prescribe opioids in “Friday night calls.” More information is still needed to guide our general dental colleagues in effective pain management with other techniques, such as utilizing NSAIDacetaminophen combinations as well as interceptive physical therapy techniques for the most common of the chronic pains with a musculoskeletal involvement. This means that current dental training should also incorporate basic knowledge and skills training in managing pain with techniques such as muscle stretching, acupressure, trigger point injections, basic cognitive behavioral therapy, and improving sleep and nutrition to reduce the burden of inflammatory and muscle pain in the human population. In our current social environment, we also need to look at the increased use of cannabis and its various subsets and incorporate our dental training to teach the effects on our patients. Courses in dental pharmacology may be geared to helping the new graduates incorporate techniques on pain management that go beyond the prescription, adding hands-on treatments that do not have the long-term detrimental effects on our patients that ever-increasing dependence on “pills” has forced us to confront in dentistry.