Emergency Department Referral Model in Action: Addressing Dental Access Opioid Prevention and Pain Management

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Course Overview

The high frequency of utilization of the hospital ED by patients seeking care for non-emergent dental conditions provided the impetus for Mercy Health, Ohio’s largest healthcare provider, to develop strategic approaches to pain management and the opioid crisis by creating a definitive care concept, an evidence-based pain management curriculum, a substance abuse screening tool, and strategic utilization of the electronic medical record to track inappropriate prescribing profiles to alert and educate prescribers relative to best practices.

After completing this courses, participants will be able to:

• Understand the development, operational approach and rationale for implementing the Definitive Care Concept
• Recognize evidence-based approaches to pain management including preoperative, perioperative, and postoperative approaches
• Recognize the benefits of creating tools to improve identification of at-risk patients, encourage early treatment referrals, establish acute withdrawal protocols and provide more efficient access to available PDMP databases

Presented by the ADA Council on Advocacy for Access & Prevention and M. Frank Beck, DDS, FAAHD, MAGD, FICOI, DSCDA

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Overview

This course educates dental providers on the new evidence-based clinical practice guideline (CPG) for the management of acute dental pain. The CPG was developed as part of the FDA funded research project titled, "Evidence-based Clinical Practice Guideline for the Management of Acute Dental Pain: Development, Implementation, and Evaluation Using Data Analytics to Target An Implementation Strategy." The project is a collaboration between the ADA Science & Research Institute, the University of Pittsburgh, and the University of Pennsylvania.

Presenters
Deborah Polk, PhD, Assistant Professor, University of Pittsburgh
Paul A. Moore, DMD, PhD, MPH, Professor emeritus, University of Pittsburgh

Learning Objectives

After completing this course, you should be able to:
• State the benefits of NSAIDs over opioids
• List examples of recommendations from the clinical practice guideline for the management of acute dental pain
• Use communication skills with patients
• Incorporate patient responses into and develop a plan for a patient’s pain management
• Begin to incorporate the guideline into practice

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Many older people have a variety of systemic diseases that have an impact on their oral health care. Analgesic medications may be part of a patient’s comprehensive treatment plan for relieving pain.

Pain management in older, medically complex patients requires special considerations. As physiologic, cognitive, and social factors change, so does the approach to patient centered management of oral healthcare. Dentists prescribing opioids for pain management has evolved but increased awareness to identify misuse, specifically by older adults is needed.

Upon completion of the archived webinar participants will:

• Describe special considerations for treating older adults, assessing their pain and interpreting their health status.
• Review risk factors for opioid toxicity in older adults.
• Review opioid misuse in older adult population.

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Drs. Sharon Parsons and David Kimberly presented a one hour webinar on October 21, 2021 that covered the important topic of Opioids, Dentistry and Addiction: The Dentist’s Role in Treating Pain. The United States experienced a tragic rise in drug overdose deaths in 2020, which was largely caused by inappropriate use of opioids. Viewers will hear from a practicing dentist and an oral surgeon about the positive role dentists can play to help mitigate the opioid crisis. Additionally, viewers will gain a better understanding about substance use and addiction as well as learn about the best options currently available for the treatment of acute pain.

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Wilson Compton, M.D., M.P.E. is a nationally known expert on the causes and prevention of drug abuse and is the Deputy Director, National Institute on Drug Abuse (NIDA). During this on-demand webinar, recorded November 10, 2021, he will present a comprehensive overview of the state of the opioid crisis amidst the COVID-19 pandemic and the various initiatives at the National Institutes of Health (NIH) to combat that crisis as well as COVID-19. Dr. Compton’s presentation will include a review of multiple NIH collaborative efforts to address interdisciplinary challenges associated with the pandemic and the “Helping to End Addiction Long-Term (HEAL) Initiative:” a trans-agency effort to speed scientific solutions to curb the opioid public health crisis. Additionally, he will summarize the science and tools available to dentists as they are addressing substance use issues in their clinical practices.

Viewers of this webinar will be able to:

• Identify novel treatments for substance use disorders and drug-involved overdose
• Review implementation science with the goal to improve the uptake and delivery of evidence-based care
• Discuss ways to talk to patients appropriately about substance use while avoiding stigma
• Review current screening tools such as the "Words Matter'' CE activities and the NIDAMED web portal

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This on-demand webinar from July 21, 2021 will cover evidence-based strategies for integrating controlled substance risk assessment into the dental practice. These strategies include: a review of the prevalence of substance misuse and abuse among dental patients, reducing risk by brief structured assessment, recognizing comorbid patient risk factors, usage of state prescription drug monitoring programs, and inter-professional collaboration with colleagues in addiction medicine/mental health, primary care, and pain medicine.

Viewers will learn strategies for delegating aspects of assessment and management to dental hygienists and other supervised clinicians. Barriers to implementation will also be discussed. The above template for care is based upon current work in development through the Tufts Controlled Substance Risk Mitigation Project.

Upon viewing this webinar, you will be able to:

• Recognize patient risk factors for misuse and abuse of controlled substances
• Review tools for assessing patient risk, including validated screeners and state prescription drug monitoring program databases
• Identify strategies for improved inter-professional care of complex patients with active substance use disorder

Join the ADA Council on Dental Practice and Providers Clinical Support System (PCSS) to learn how dental professionals can describe safe pharmacological management of acute dental pain, propose conversations and education for opioid use and misuse and the need for referral of patients and providers. (2 CE Credits)

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