Opioid Analgesic Prescribing Practices of Dental Professionals in the United States

The prescription of opioid analgesics by dental professionals is widespread in the United States. Policy makers, government agencies, and professional organizations consider this phenomenon a growing public health concern. This study examined trends in the prescription of opioid analgesics for adults by dental professionals and associated factors in the United States. Data from the Medical Expenditure Panel Survey (1996-2013) were analyzed. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to estimate the overall trend during the period with and without adjusting for dental procedures and personal characteristics. Survey weights were incorporated to handle the sampling design. The prescription of opioid analgesics following dental care increased over time. After adjusting for sociodemographic factors, source of payment, and type of dental procedure, the odds ratio (OR) of prescribing opioid analgesics following a dental visit per each decade difference was 1.28 (95% confidence interval [CI], 1.19–1.38). Surgical, root canal, and implant procedures had the highest rates of opioid prescriptions and the greatest increases in rates over the study period. After adjusting for personal characteristics and type of dental procedure, the OR of receiving a prescription for opioids comparing blacks, Asians, and Hispanics to whites was 1.29 (95% CI, 1.17–1.41), 0.57 (95% CI, 0.47–0.70), and 0.84 (95% CI, 0.75–0.95), respectively. Opioid analgesic prescriptions following dental visits increased over time after adjusting for personal characteristics and type of dental procedure. The odds of receiving a prescription for opioids were higher for certain racial/ethnic minority groups. Knowledge Transfer Statement: This study highlights dental professionals prescribing practices of opioid analgesics by following dental treatments in the United States. With this knowledge, appropriate guidelines, protocols, and policies can be developed and implemented to address any inappropriate prescribing practices of opioid analgesics. In addition, this information could lead to an improvement in the prescribing practices of dental professionals and to evidence-based therapeutic decision making

Trends and Racial/Ethnic Disparities in Antibiotic Prescribing Practices of Dentists in The United States

Objective The aim of this study was to examine trends and racial/ethnic disparities in antibiotic prescribing practices of dentists in the United States. Methods The US Medical Expenditure Panel Survey data for 1996‐2013 was analyzed. Information on patient sociodemographic characteristics, dental visits, receipt of dental procedures, and type of antibiotics prescribed following visits was obtained. Descriptive statistics were calculated separately for each year. Logistic regression analyses were conducted to identify associations during the period with and without adjustment for dental procedures and sociodemographic characteristics. Survey weights were incorporated to handle the sampling design. Results Nationally, the number of antibiotic prescribed at dental visits was estimated to be higher by 842,749 (0.4 percent) at year 2013 compared to the prescription level at 2003 were the population sociodemographic distribution kept at 2013 level. On average, the odds of prescribing antibiotics following dental care increased with each decade of study (OR: 1.10; 95% CI: [1.04, 1.17]) after adjusting for sociodemographic characteristics and receipt of dental procedures. Compared to Whites, Blacks had 21 percent (95% CI: 11%, 31%) higher odds of receiving a prescription for antibiotics from a dentist after adjusting for dental procedure and other sociodemographic characteristics. Conclusions The prescription of antibiotics following dental visits increased over time after adjustment for sociodemographic characteristics and dental procedure. The probability of being prescribed antibiotics by dentists was higher for Blacks compared to Whites

Determination of utilization in a dental insurance plan

Thesis (M.Sc.D.)--Boston University. Henry M. Goldman School of Graduate Dentistry, 1990 (Public Health Dentistry)Bibliography: leaves 39-40.The objective of this study was to determine and compare the dental care utilization of 37,000 New England employees, insured by Empire Blue Cross Blue Shield and Metropolitan Life insurance companies under dual option, preferred Provider ( Closed) Plan and Open Plan. This investigation was carried out by a random selection of 5,000 records of insurees. Comprehensive statistical analysis was performed to evaluate dental services provided through both dental insurance plans. Dental services were broken down by the ADA Procedure Code classification and service mix statistically examined in relation to Plan type ( Open, Closed), claim administrator (Empire, MetLife) and eligibility type (Employee, Spouse and Dependent). This sample comprised of members (employees), their spouse and dependents who, overall, formed a group of 2064 (41.3%) males and 2936 (58.7%) females. Of the total 5000 dental claims filed 1929 (38.6%) were through the Open Plan and 3071 (61.4%) through the Closed Plan. Specifically, for each dental procedure claims were counted with either Plan type

Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints.

In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group 'Infection' of Swiss Orthopaedics. Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints

A Retrospective Study of Operating Room Utilization and Efficiency in a Pediatric Dental Residency Program

Purpose: The purpose was to assess and understand operating room (OR) utilization and efficiency in a pediatric dental residency program. Methods: A retrospective study was performed using chart extraction from 778 patients completed by both pediatric dentistry faculty (n=7) and residents (n=17) in an ambulatory care setting over a 32 month period (between July 2010 and March 2013). Patterns in OR usage time were determined by documenting various timing metrics (start and stop times for anesthesia, start and stop times for the dental procedure, times for throat pack in and out), noting patient information (age and ASA patient classification status), and creating variables by grouping data by clinical provider type and dental procedure. OR usage time was analyzed using multiple regression to estimate the per-tooth or per-mouth time for each type of procedure. Results: The median procedure time was 75 minutes (range= 1 to 517 minutes). Multiple regression indicated that for the average patient, a faculty member took 63.8 minutes (95% CI = 60.8 to 66.7 minutes) and a resident took 81.9 minutes (95% CI = 78.7 to 85.0 minutes, P\u3c.0001).These results demonstrate that the appropriate scheduling of operating room should be based on the proficiency level of provider as well as the complexity of the dental procedure. Conclusion: This study concludes that pediatric dental operating room planning and scheduling in teaching hospitals should take into account real constraints such as residents’ level of training and skill

Nanomagnetic-Mediated Drug Delivery for The Treatment of Dental Disease

Maintaining the vitality of the dental pulp, the highly innervated and highly vascular, innermost layer of the tooth, is a critical goal of any dental procedure. Upon injury, targeting the pulp with specific therapies is challenging because it is encased in hard tissues. This project describes a method that can effectively deliver therapeutic agents to the pulp. This method relies on the use of nanoparticles that can be actively steered using magnetic forces to the pulp, traveling through naturally occurring channels in the dentin (the middle layer of the tooth). This method can reduce the inflammation of injured pulp and improve the penetration of dental adhesives into dentin. Such a delivery method would be less expensive, and both less painful and less traumatic than existing therapeutic options available for treatment of injured dental pulp. This technique would be simple and could be readily translated to clinical use

Management of dental anxiety via distraction technique

The purpose of this study was to evaluate the use of a stress ball as a distraction technique on stress levels of patients undergoing a dental procedure. A randomized, split-mouth design was conducted using 20 adult subjects requiring scaling and root

Streptococcus viridans osteomyelitis and endocarditis following dental treatment: a case report

Vertebral osteomyelitis is an uncommon complication of infective endocarditis with the organism Streptococcus viridans being a rare cause of the condition. This case highlights an unusual presentation of Streptococcus viridans associated with infective endocarditis and pyogenic osteomyelitis in a patient following a dental procedure

Hypoglossal nerve paralysis in a child after a dental procedure

Unilateral palsy of the hypoglossal nerve is a rare complication of orthodontic procedures. The main reported causes of HNP are: orthopedic and otorhinolaryngology surgical interventions, and in particular maneuvers involving compression or overstretching of the hypoglossal nerve, dental procedures and traumas, and also infections, motoneuron disorders, tumors, vascular diseases. Diagnosis is usually performed by electrophysiology studies (EMG-VCN), and brain magnetic resonance imaging (MRI) is useful to exclude other causes. The prognosis depends on the location and extension of the damage. Currently there is not a standardized treatment approach except the speech therapy, although, in some cases, the high-dose steroid treatment could be useful. We describe the case of a ten-year-old female, who was admitted in our Unit after a deviation of the tongue associated with dysarthria and dysphagia, occurred after the application of a mobile orthodontic device

An unusual case of chronic cough: Professional liability in dentistry?

Foreign body aspiration (FBA) is a serious medical problem, also in dental practice. The case report describes the case of a patient who for 12 years has suffered from chronic cough as a result of the aspiration of a polymeric silicone resin fragment during a dental procedure. In November 2002, the patient was underwent dental care, and she points out that, when performing dental imprint, she had sensed that something "went down in the throat" but she was immediately reassured by the dentist. After lung CT was performed, the foreign body was identified and removed with benefit to the patient. The knowledge of this case report could be useful for dentists who perform dental impressions, to be aware of the fact that the material used is radiolucent e.g. cannot be seen on plan radiographs and it can be accidentally inhaled by the patient. The knowledge of the case is also important for doctors who come in contact with patients who previously underwent dental treatment, suffering from persistent cough, in the absence of positive radiological signs