IHS Introduces Recommendations for Management of Acute Dental Pain
By Cmdr. Brandy Larson, DDS, Dental Director, Cass Lake Indian Health Service Hospital Dental Clinic
The Indian Health Service released new clinical guidelines to assist dentists with selecting the safest pain control options. The Recommendations for Management of Acute Dental Pain will limit opioid prescribing to patients who cannot safely use alternative pain medication.
Led by the Division of Oral Health, in collaboration with the IHS National Committee on Heroin, Opioids and Pain Efforts, the guidelines were developed by an inter-professional workgroup consisting of both dentists and pharmacists. The guidelines aim to reinforce evidence-based acute pain management strategies, including optimizing non-steroidal anti-inflammatory drugs, acetaminophen, and topical/local pain strategies to avoid or reduce opioid use. The guidelines also include a decision tree for pre- and post-operative pain management, as well as recommended dosing of systemic analgesics based on anticipated operative pain.
Approximately 18.5 million opioid prescriptions are written annually by dentists in the United States, accounting for 12% of prescribed immediate release opioids. Despite this volume, there is evidence showing that nearly half of all opioids prescribed by dentists post-operatively go unused, which can result in non-medical use or diversion of the unused medications. Additionally, opioids prescribed after wisdom teeth removal are frequently the first opioid experience for patients under the age of 25. Opioid use at this age can alter brain development and increase the risk of developing substance use disorders. Reducing unused opioids and opioid exposure in the adolescent and young adult populations are two critical strategies to combat the opioid epidemic.
The new clinical guidelines include recommendations to address strategies for both the general population and more medically complex populations. Medically complex patients include those:
with allergy and drug intolerances
who are pregnant
with substance use disorders
with gastrointestinal conditions
with kidney and liver impairment
with respiratory impairment
taking blood thinners
being treated with benzodiazepines, medication commonly used to treat conditions such as anxiety, nervousness and panic disorders
being treated for chronic pain
utilizing medication--assisted treatment for substance abuse
The guidelines are available on the HOPE Committee’s Pain Management website: https://www.ihs.gov/painmanagement/treatmentplanning/dentalpain/