PEKIN — The American Dental Association is making strong recommendations for its members on opioids, noting dentists often introduce young people to the addictive drugs.
“3.5 million kids have their wisdom teeth taken out each year, and 85 percent are receiving opioids,” said Dr. Paul Moore, ADA spokesman and professor of pharmacology, dental anesthesiology and dental public health with the School of Dental Medicine at the University of Pittsburgh. “Those kids are very likely being exposed to opioids for the very first time.”
While dentists are not the biggest prescribers of opioids, the fact that they prescribe to so many young people gives them a special responsibility, said Moore.
Most area dentists are likely in agreement with the ADA’s newest recommendations, said Timm Schwartz, a retired Pekin dentist who serves on the Illinois State Dental Society and the Illinois Board of Dentistry.
“It’s obviously a serious problem, and dentistry has been dealing with this and addressing those problems for a number of years,” he said during a recent phone interview. “There’s still more that needs to be done and I think the ADA’s guidelines are right on track.”
In March the ADA asked dentist to limit opioid prescriptions to seven days and to receive mandatory opioid training acceptable for both their Drug Enforcement Administration registration and state dental board requirements. The group also gave support for dentists registering with and utilizing the prescription drug monitoring programs in states that have them.
Illinois has a drug monitoring program that became mandatory this year, and most dentists in Illinois are probably already following the prescription guidelines, said Schwartz. But Illinois is not yet requiring opioid training for dentists.
“Illinois has continuing education requirements, but there is no requirement for pharmacology,” said Schwartz. Every three years dentists are required to get additional training when renewing their licenses. Educational topics generally focus on new advances in the profession, so it’s possible opioid training could be incorporated into that training, said Schwartz.
While the ADA is making a strong statement about opioids, the organization doesn’t have the power to enforce its recommendations. States license dentists, so the recommendations must be adopted by each individual state. Until then, the rules are likely to vary from state to state. One way to get a blanket rule across the United States is if the DEA were to make it a requirement, said Schwartz.
“The federal government could say ‘in order to get your DEA license, you have to have continuing education on opioids,’” said Schwartz. “That hasn’t been done, but it might. It would be a way to create a mandate nationwide.”
By making its recommendations, the ADA is helping the DEA to do just that, said Moore.
“Now the DEA has the support of the ADA to create a new policy,” he said.
Dentist prescribe for acute pain, not long-term pain. In most cases patients would be better served to take a combination of acetaminophen and ibuprofen, said Moore, who is the lead researcher in a study published in the Journal of the American Dental Association this month which examines the effectiveness of different pain medications following dental procedures.
“Patients are numb when they walk out the door, and we have to predict if they are going to have pain 12 hours from now. The majority would probably do perfectly well with Advil or Naproxen,” he said.
In fact, a seven-day opioid prescription is, in most cases, too much, said Moore.
“Two to three days is most often adequate,” he said. “Seven days is rare. Certainly that’s true for dental surgery. If you are really in serious pain in seven days there is probably something wrong and you should see a doctor.”
As one of the people shaping the ADA’s new policy, Moore is pleased the organization is taking a proactive approach to addressing the opioid epidemic. Since dentists see their patients frequently, they have an opportunity to educate a wide swath of the public about opioids.
“We can say ‘here’s a prescription for eight tablets of Vicodin. You don’t have to fill it, but you will have it if you need it. You probably won’t need it if you take Advil in combination with acetaminophen,’” said Moore.
And since dentists are frequently the first doctor to prescribe an opioid to a young patient, the conversation is even more important.
“The average age kids have their wisdom teeth taken out is 18 to 22 years,” said Moore. “The control centers in the brain which keep you from doing really foolish things don’t get fully developed until you are well into your 20s.” Studies have shown that even kids who aren’t risk takers are at risk for abusing opioids five years after that first prescription, he said.
“So we have reason to be concerned, and with this recommendation we are saying we have a responsibility.”
Leslie Renken can be reached at 686-3250 or firstname.lastname@example.org. Follow her on Twitter.com/LeslieRenken, and subscribe to her on Facebook.com/leslie.renken.