Kristin Hohman has served as Associate Editor of Dental Products report since 2019. She has a background in journalism and digital content. Kristin can be reached at khohman@mjhlifesciences.com.

Kristin Hohman

RevenueWell Phone is an all-in-one communication hub that integrates with a practice’s patient management system and delivers coordinated voice, 2-way text messaging, email, and video conferencing, all of which is tied to the practice’s existing phone number. The mobile app allows teams to manage the practice from anywhere, so dentists and office staff can make and receive calls on the go. The system is cloud-based and integrates with RevenueWell’s existing suite of patient relationship management solutions.

As an office manager, Marissa Rosario is responsible for much of the day-to-day activity at Midwest Dental Center in Westchester, Illinois. This includes maintaining the office’s patient schedule, billing, following up with health insurance, and ensuring each patient has a positive experience at the practice.

Since joining the practice about 4 years ago, Rosario has become familiar with RevenueWell, whose products the practice began working with a few years ago. When the company released RevenueWell Phone, Midwest Dental Center was almost instantly sold on the new software, Rosario says.

“We had a small meeting to go over all of the features,” Rosario notes. “That really did it for us.”

RevenueWell Phone is a new proprietary voice over internet protocol phone and text messaging system that is designed specifically for dental practices. This addition to the company’s existing suite of patient relationship management solutions is designed to offer front office staff a new way to drive appointment scheduling, case acceptance, and productivity while minimizing time spent on the phone.

Midwest Dental’s previous phone system did not provide many of the features that dental patients are looking for, according to Rosario. She specifically highlighted RevenueWell Phone’s texting feature, which not only allows the practice to automatically send texts but allows them to be sent in the patient’s preferred language.

“One of the things we liked the most is that they offer texting in Spanish,” Rosario says. “If we put an ‘S’ in certain places in the chart, it will text patients in Spanish automatically.”

The user-friendly phones allow the practice to utilize the functionality very easily and to quickly train members of the Midwest Dental Center team.

RevenueWell Phone is an all-in-one communication platform designed to integrate with a practice’s existing practice management system. It delivers coordinated voice, 2-way texting, email, and more, all using the practice’s existing phone number.

The cloud-based software can also integrate with RevenueWell’s existing suite of marketing and patient communication solutions, including the Marketing Platform, Messenger, and Forms products.

The system is said to boast over 100 features that can be customized to best fit a front desk team’s operations. RevenueWell Phone helps practices and staff eliminate missed opportunities and communication snags and facilitate connections with patients, all while helping simplify phone management and workflows.

The platform’s Screen Pop feature allows staff to see who is calling before answering the phone. It also displays valuable information from the practice management software, such as appointments, treatments, insurance information, and unpaid balances. This feature also enables staff to answer questions quickly and accurately with a more personalized touch.

“Everything is online. Everything is paperless. So we can do promos and online campaigns and we can text patients,” Rosario says. “I like that patient reminders are automatic. We can see a lot more about the practice. I also like how the text messages have their own individual plan. I like how the phones are connected with text messages. We can just do a lot more.”

Articles

How RevenueWell’s new Phone system makes day-to-day tasks easier for one office manager and her entire team.

This System Helped One Practice Improve Efficiency 

Information provided by Freedom Technologies Group.

Every dental practice looking to upgrade to digital radiography.

Whenever digital images are needed and for any practice seeking durability, diagnostic image quality, and comfort compared with their current digital imaging system.

DC-Air is a wireless intraoral x-ray sensor with Bluetooth Low Energy technology, which enables the sensor to quickly and reliably transfer images to the receiver connected to a PC. This eliminates what is said to be the No. 1 failure point of other sensors—the wire. Its holders use a patent-pending design that eliminates bulk from the sensor’s profile in the mouth. Coupled with the DC-Air’s thin silhouette, it’s designed to ensure patient comfort and easy positioning.

The DC-Air’s direct-conversion technology provides greater native sharpness than other sensors on the market that have to convert x-rays to visible light before creating an image. This also adds to the sensor’s durability by eliminating glass plates and other fragile components that are used in indirect conversion sensors. DC-Air is constructed with a solid casing and homogenous internal components. It has an IP67 rating, allowing it to withstand the rigors of daily use.

A truly wireless x-ray sensor with integrated Bluetooth technology, the DC-Air is built for durability and provides crystal-clear digital images. 

5Ws* FTG DC-Air™ Intraoral Sensor

This month, we turn our focus to primary teeth with our cover story on the advancements made in pediatric dentistry. For children, there is a lot of excitement around the loss of baby teeth, including a visit from the Tooth Fairy and some money under their pillows. But primary teeth actually serve a few important functions that many may not realize. Here are 5 interesting facts about baby teeth.

Twenty primary teeth are already present in the jaws at birth.

 They typically appear when a baby is 6 months to 1 year old.

 Most children have their full set of primary teeth by the age of 3.

Baby teeth usually erupt in a specific order.

Every child is different, but typically breakthrough starts with their central incisors in the lower jaw, followed by the central incisors of the upper jaw.

Primary teeth differ from adult or permanent teeth in several key ways

Primary teeth enamel is usually thinner, often making them appear whiter.

Primary teeth are smaller than permanent teeth and the front baby teeth can come in with bumps that wear off over time.

The roots of baby teeth are shorter and thinner because they are designed to fall out.

Baby teeth not only help a child speak clearly and chew naturally but also provide a path for adult teeth to follow when they are ready to erupt.

Rituals surrounding the loss of baby teeth are not a new phenomenon. Every culture has its own customs, including burning the tooth, burying it in a hole or wall, or even swallowing it.

 Anthropologists have found that these customs are parallel with a society’s burial rituals.

 The closest comparison to the American Tooth Fairy comes from an 18th-century French fairy tale called “La Bonne Petite Souris” (“The Good Little Mouse”), although other myths are thought to date back much further.

5 Big Facts About Little Teeth

There is perhaps no health crisis in the past 2 decades that has come close to the current opioid epidemic. It wasn’t until the past decade that patients and prescribers began to truly understand the dangers of opioids. but the damage has been done. As opioid-induced deaths continue to climb, it is critical for the dental community to understand its role in this crisis and develop prescribing best practices.

The fact that opioids are highly addictive substances is widely acknowledged in medicine and among the general public. However, that was not always the case. Although the phrase “opioid epidemic” would not be coined until later, the crisis itself started in the 1980s and 1990s, during which a fundamental shift occurred in the way pain was treated by health care professionals.

 published an editorial written by the president of the American Pain Society that criticized the seeming lack of improvement in pain management over the past 20 years.

 The argument was that education and guidelines were not working—a failure attributed to patients not being up-front about their pain with health care providers and a general reluctance among clinicians toward prescribing opioids.

The widely accepted wisdom was that “therapeutic use of opiate analgesics rarely results in addiction,” however, this was found to be based on a single published study with few details on how the study was completed.

The following year, the American Pain Society introduced its quality and assurance standards for the relief of acute pain and cancer pain. Recommendations included the following

A simple and valid measure of pain should be selected by each unit.

Each clinical unit should identify values for pain-intensity rating and pain-relief rating that will elicit a review of the current pain therapy.

The last recommendation is likely to have led to the use of pain treatment algorithms that later proved highly problematic, especially in hindsight.

Although this was the beginning of more aggressive treatment of pain, the acceptance of pain as the fifth vital sign began even earlier, says Mark Donaldson, PharmD, BSP, ACPR, FASHP, FACHE, associate principal at Vizient, Inc, a health care improvement company based in Irving, Texas.

“If you go back to the late 1970s, beginning 1980s, there was a focus from the Institute of Medicine (IOM) that pain should be considered the fifth vital sign,” Dr Donaldson says. “Patients, as well as providers and insurance companies, really recognized that we have lots of great medications out there and interventions. And so there should be a better attempt at managing pain because it is truly crippling not only to the patient but to their loved ones, [and to the patient’s] ability to be a productive member of society.”

In 2000, then-president of the Joint Commission on Accreditation of Healthcare Organizations, Dennis O’Leary, MD, announced the standards for health care organizations to improve pain management. Dr O’Leary emphasized the need for these standards due to confusion over who was responsible for pain control, a general lack of knowledge about pain management, and misconceptions about drug tolerance and addiction. His outlook was consistent with similar positions expressed by the IOM (now the National Academy of the Sciences), American Pain Society, and US Veterans Health Administration. Although these standards were lauded by pain experts, there was concern they would lead to an overreliance on opioids. Regardless, the use of opioids continued to increase into the early 2000s.

“Pharma companies certainly do shoulder a lot of this blame,” says Dr Donaldson. “They picked up on the IOM report that pain is a fifth vital sign and that we need to start treating more aggressively, primarily with narcotics. They started to put out a little bit of misinformation that really sort of underplayed the danger associated with getting patients on narcotics.”

“There was a general misperception that perhaps these drugs were not addictive,” says Rebekah Lucier Pryles, DMD, an endodontist and co-owner at Upper Valley Endodontics, and an instructor at Harvard University School of Dental Medicine and Tufts University School of Dental Medicine. “We’ve learned that that’s obviously not the case. And we’ve also learned a lot more about how to manage both acute and chronic pain. Quite honestly, some of the push of treating pain as a fifth vital sign came from the pharma companies and the fact that doctors needed to address pain.”

In the 1990s and early 2000s, the pendulum began to swing the wrong direction, Dr Donaldson says, adding that this was when a lot of opioids were also prescribed for postoperative dental pain.

“It was almost 2 decades in the making,” Dr Donaldson says. “We’ve had problems since the early 1980s, when overprescribing first started. And the overprescribing actually coincided with some marketing strategies by pharmaceutical companies, most notably at the time was Purdue [Pharma], who makes OxyContin. You have this issue where the Institute of Medicine [was] pushing prescribers to recognize and treat pain more effectively. You [had] pharma companies coming out saying, ‘Ours is the best. Ours does not cause addiction.’ That was one of the big misnomers but was part of the original OxyContin and oxycodone marketing. So we ended up getting a lot of people, unfortunately, hooked on narcotics.”

This was the start of what we now recognize as an epidemic; nearly 841,000 Americans died of a drug overdose between 1999 and 2019. In 2019 alone, 70,630 drug overdoses occurred in the United States, 70.6% of which were opioid-related. Opioids, and more specifically, synthetic opioids, are the main drivers of drug overdose deaths.

In a 12-month period ending April 2021, more than 100,000 Americans died of an overdose, a 30% increase from the previous year. This marks the first time the US has exceeded 100,000 deaths per year, which is more than motor vehicle accidents and gun fatalities combined.

These stark numbers serve as a reminder why health care professionals, including dentists, should exhibit caution when prescribing opioids—if opioids are to be used at all. Many individuals addicted to synthetic opioids likely became addicted after being given prescription opioids by medical providers.

Between 2011 and 2015, dentists were responsible for 1 in 10 opioid prescriptions in the US, with 29% of prescribed opioids exceeding the recommended morphine equivalents for appropriate management of acute pain.

 Approximately half (53%) of these prescriptions exceeded the recommended days’ supply, and between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed.

The attitude in health care was that not giving patients strong pain medication meant clinicians were neglecting their patients’ care, says Brooke Blicher, DMD, an endodontist and co-owner at Upper Valley Endodontics with Dr Pryles, and an instructor at Harvard University School of Dental Medicine and Tufts University School of Dental Medicine.

“If you’re not giving pain medication, you’re a terrible provider, [and] you’re ignoring your patient. Dentistry definitely got wrapped up in that. I think this isn’t just dentistry, but you form a lot of your habits when you train. [So, people in the ’80s and ’90s] were trained to give opioids, and that’s what we were doing. [We] didn’t know any better [then],” Dr Blicher explains.

“I think that dentists have in the past predominantly prescribed opioids for moderate to severe pain in a lot of their patients, probably more so than nonopioid drugs,” says Arthur Jeske, DMD, PhD, professor and associate dean for strategic planning and continuing dental education at The University of Texas Health Science Center at Houston School of Dentistry, editor in chief of 

. “But the quantities that they prescribe in no way exceed those prescribed by physicians. One of the reasons for their previous reliance on opioids has been the fact that opioids are controlled substances and are perceived to be superior to other pain control entities because they are subject to [US Drug Enforcement Administration] control.”

It is true that dentists are not solely responsible for the previous attitudes in medicine surrounding opioid use. A 2017 study from National Public Radio found that dentists ranked fourth in 2012 in opioid prescribing rates when compared with their medical colleagues.

 Although, historically, dentists and oral surgeons were robust utilizers of opioids in pain management, Dr Pryles says that has changed over the past few years as new information and best practices have become available.

“Dentists have significantly curbed their prescriptions of opioids in the past 5 years thanks to the availability of new information that’s out there,” Dr Pryles says. “I think the large numbers of prescriptions that were available, there were twofold reasons for them: First, there was a push from big pharma to get these drugs into patients’ hands, and the misperception that perhaps they were not addictive [was] being spread as well. I also think that there was a lack of good resources and good research on pain management. I think we swung from a culture in medicine and dentistry of patients being told to suck it up—that pain was normal—to the complete opposite end of the spectrum, where we as clinicians had to get rid of all of patients’ pain,” she says.

More recent data show that opioid prescriptions are trending downward. A study published in August 2021 in the Journal of the American Dental Association found consistent decreases in opioid prescription rates in dentistry during the study period.

The results showed a decrease in the percentage of patients receiving an opioid in a given year, declining from 2.7% in 2012 to 1.6% in 2019 among children (aged 0-20 years) and from 28.6% to 12.2%, respectively, among adults (aged 21-64 years). Although this pattern is encouraging, investigators noted these results still show that the overall rate is still too high and that prescriptions are being written unnecessarily.

“I think the concern that dentists have is that patients may be undertreated for pain,” says Mea A. Weinberg, DMD, MS, a clinical professor of periodontology and implant dentistry at the New York University School of Dentistry. “They don’t want them to go home in pain. They think they need to do the top of the line so that the patients will not feel anything.”

Over time, dental opioid prescribing has decreased by approximately 20%.

 Although this decreased trend is certainly a positive, it comes too late for so many. It’s hard to reverse course with such addictive substances, Dr Donaldson says.

“Over the last 10 years with the recognition of the opioid epidemic, we’ve tried to reverse the Queen Mary, but that’s been a significant challenge,” he says. “Of course, narcotics are very addictive, certainly in [particular] patients. One in 16 patients who have a single dose of an opioid will become an addict...and you just don’t know who that 1-in-16 person could be.”

An individual can be introduced to opioids in a dental setting at a young age, which is mainly attributed to third-molar removal. A 2018 study suggested that opioid-naïve patients who receive an opioid prescription from a dental clinician may be at risk for persistent opioid use and abuse.

“Young adults usually get their wisdom teeth removed around the age of 17 to 18 [years],” says Walter Tatch, DDS, FACOMS, an oral surgeon at NorthShore Center for Oral & Facial Surgery and Implantology near Chicago, Illinois. “It is possible that they may have their first experiences with opioids at that time. We have clearly shown in our practice over a number of years that it is possible to use alternatives to heavy opioids to adequately control pain and avoid abuse potential.”

COVID-19 has exacerbated many systemic health care issues across the board—including the use of opioids and other addictive substances. COVID-19 pandemic–related stresses have triggered an increased use of opioids, alcohol, and cannabinoids.

 In addition, data show at least a 15% increase in stress-associated dental or oral health complaints—including daytime clenching and nighttime grinding—versus pre-pandemic times.

“It’s hard to think that [COVID-19] doesn’t have an impact on [all walks] of what used to be our normal lives,” Dr Donaldson says. “Certainly, during the early days of the [pandemic], [when] people were encouraged to social distance, mask up, stay at home, you saw a significant drop in patients going to the dentist. Unless it was for an emergency procedure, patients have preferred to stay out of hospitals, stay out of dental offices, stay away from everybody. I still think that [although] we have historically always been encouraged to visit our dentist every 6 months for [a] routine hygiene checkup, because of COVID-19, people put a lot of that off.

“Now that they may be returning to the dental office because they have been less proactive in their oral health care, they’re coming in with worse situations, maybe more painful situations,” he continues. “Through preventative measures caught early on, they might not have proceeded to the point [at] which they now require significant pain management to get on top of their issues.”

This, Dr Donaldson says, is putting undue pressure on dental prescribers, who are being told by their patients that acetaminophen and ibuprofen are no longer working.

Although Dr Tatch never closed his practice during the pandemic, he understands that COVID-19 has resulted in consequences for dental patients.

“I do oral maxillofacial surgery, so we never closed our practice. We went from seeing regularly scheduled patients to emergency patients—patients with severe infections, facial trauma, and things like that,” he says. “But [not] having exposure to dental care, that certainly impacts dental health if patients are not [being seen] in general dentist offices for their routine care for the cleanings. A lot of patients have significantly increased cases of temporomandibular joint problems because of stress, impaired function, and that goes along with not being able to be seen in dental practices for their routine appointments.”

COVID-19 not only forced practices to close for several weeks during 2020, keeping patients from much-needed care, but it has also underlined the fractures already present in the health care system. Systemic disparities in access to treatment, gaps in insurance coverage, and economic instability were at the root of the opioid epidemic before the COVID-19 pandemic took hold.

Early data suggest that COVID-19 and efforts to mitigate the spread of the SARS-CoV-2 virus have compounded these disparities, likely contributing to increased fatal and nonfatal opioid overdoses specifically and to increased substance abuse behaviors more broadly. Certain racial and socioeconomic demographics have poorer oral health, including non-Hispanic Black individuals and Mexican American adults, who exhibit twice the rates of untreated caries as non-Hispanic White individuals.

 Additionally, low-income or uninsured adults are 3 times more likely to have 4 or more untreated cavities versus adults with higher income levels or dental insurance.

 Similar statistics can be found in the field of pain medicine, with Black patients less likely than White patients to receive analgesic medication for pain, regardless of age or socioeconomic status.

COVID-19 has not only driven these inequalities but also highlighted the social and economic factors that cause them. Racial and ethnic minorities experienced disproportionately higher rates of COVID-19 infection, hospitalization, and deaths, and the pandemic has also produced disparate effects on socioeconomic conditions in communities of color.

 Take employment as an example. Minority groups have experienced higher rates of job loss. In April 2020, national unemployment rates were 16.7% for Black Americans and 18.9% for Hispanic Americans versus 14.2% for White Americans. Employment status affects a myriad of socioeconomic conditions, such as financial stability, food and housing security, and health insurance coverage—with ensuing impacts on health and dental care.

Further, pandemic lockdowns also unraveled social safety nets and precipitated a rise in mental health disorders such as anxiety and depression.

 The lockdowns also postponed treatment for substance abuse and similar services while contributing to the death toll—mostly the death of individuals who were already addicted or suffered a relapse that was exacerbated by stress and isolation.

Courtesy of the National Institute on Drug Abuse.

*Among deaths with drug overdose as the underlying cause, the prescription opioid subcategory was determined by the following ICD-10 multiple cause-of-death codes: natural and semi-synthetic opioids (T40.2) or methadone (T40.3). 

Although the number of deaths due to prescription opioids has been on the decline, deaths due to synthetic opioids have skyrocketed since 2015 

Overdose deaths have more than doubled since 2015, with the vast majority caused by synthetic opioids—fueled by rampant use of fentanyl, a fast-acting drug that is 100 times more powerful than morphine.

The increased use of these synthetic opioids makes it all the more important that dental professionals find alternatives to curb addiction.

The nonsteroidal anti-inflammatory drugs (NSAIDs) class of analgesic medications is one of the most prescribed, and their effectiveness for treating acute pain has been well proven.

 In addition, nonopioid analgesics such as NSAIDs should be considered the drugs of choice for acute routine pain management, according to the American Dental Association.

A 2015 systematic review published in the Cochrane Library was a turning point, Dr Jeske says.

“We became aware of actual quantitative outcomes involving single doses of oral analgesics,” he says. “That was a very important publication because it established the fact that the simple combination of ibuprofen with acetaminophen was actually superior to nearly all opioids and opioid-combination products with acetaminophen. Those findings very much revolutionized our approach to acute postoperative pain control.”

When determining the best pain medication for your patients, it is important to consider the inherent differences in each drug class and to understand dental pain more broadly. NSAIDs reversibly inhibit the enzyme cyclooxygenase (or COX), a precursor to inflammation. NSAIDs also play a role in inflammatory and nociceptive pain processes.

Opioids, however, bind to specific receptors in the central nervous system, reducing pain perception and pain reaction while increasing pain tolerance.

 They are also associated with a variety of other adverse effects, including drowsiness, respiratory depression, nausea, and vomiting.

Most dental conditions are inflammatory in nature, so NSAIDs are better suited to treat the specific issue because opioids only mask the pain, Dr Tatch says.

“A lot of times it’s actually counterintuitive to provide opioids because they really do not have a great anti-inflammatory component,” he explains.

Additionally, a combination of acetaminophen and a NSAID has been shown to offer superior analgesic effects to either drug alone with fewer adverse effects or without the possibility for abuse compared with opioids.

 The Vega Recovery kit from StellaLife is formulated as adjunctive therapy for pre- and postsurgical treatment. It includes an antimicrobial rinse, a sublingual spray, and a topical gel.

“I think today, we realize that really very few postoperative dental patients should require narcotics. The appropriate prescribing of analgesics for postoperative dental pain should not include opioids,” Dr Donaldson says.

The use of acetaminophen, with or without the use of a NSAID such as ibuprofen, should be the first line of therapy barring any contraindications, Dr Donaldson adds.

Since 2015, Dr Tatch’s practice has essentially eliminated the use of opioids altogether. “That means that hydrocodone (Vicodin) [and] Percocet [are] not part of our vocabulary when it comes to the postoperative management,” he says. “Occasionally we’ll use a very mild schedule for opioid, like tramadol, just for breakthrough pain.”

In a cohort study of his patients published in the Journal of Oral and Maxillofacial Surgery, Dr Tatch found his practice was able to significantly reduce the percentage of his patients receiving opioids postoperatively. At the start of the study before the restriction on opioids was in place, approximately 2106 patients between the ages of 15 and 85 years underwent surgical procedures, 1184 (59%) of whom required and filled strong opioid prescriptions.

 In 2017, that number was reduced to 19%, even as the number of surgical procedures remained relatively equal.

“We’ve been able to decrease the number of heavy opioids we prescribe three-fold, which, for a full-scope oral and facial surgery practice, is quite astonishing,” Dr Tatch says. “Our study was published in 2019 and since then, we’ve completely eliminated prescription hydrocodone/oxycontin related medications.

The opioid alternatives Dr Tatch has found success with include NSAIDs, acetaminophen, and the Vega Oral Care Recovery Kit from StellaLife 

. The kit is a homeopathic medicine that is formulated as adjunctive therapy following surgical treatment. It is said to significantly reduce narcotic pain medications and steroids.

The natural Vega kit includes antimicrobial rinse, sublingual spray, and topical gel. It is indicated for a variety of uses, including all dental surgical procedures such as extractions, bone and tissue grafting, implant placement, and biopsies.

“StellaLife is a wonderful adjunct to postoperative recovery. Not only does it have analgesic properties, but it also accelerates healing,” Dr Tatch says.

 First introduced in the US in 2021, Exparel works locally using DepoFoam® delivery technology, which gradually releases bupivacaine over time.

At their endodontics practice in Vermont, Drs Pryles and Blicher also avoid the use of opioids. Instead, they rely on NSAIDs and acetaminophen.

“We know based on the literature that’s available that the single most effective drug for managing postop pain is a combination of ibuprofen and Tylenol,” Dr Pryles says. “That is what I’m recommending, barring any medical history or contraindications, for all of my patients. We know that it works better than anything that’s out there.”

Their office also found that using a local anesthetic as an analgesic can be a good stopgap, especially for patients who are experiencing pain but are not able to be seen immediately, Dr Blicher adds.

“We’ll use a medication called bupivacaine (brand name Marcaine, Septodont), a long-acting anesthetic in the amide family. We administer it the same way,” she explains. “If I have a patient that comes into my office and they’re in tons and tons of pain, and either I can’t see them for a few hours, or they need to get in for an extraction instead—and they can’t be seen for a few hours—we can numb them up.”

If a patient comes in that she feels may have a bit more postoperative discomfort or chronic pain, or even if they cannot take ibuprofen or acetaminophen, Dr Blicher will administer bupivacaine right before treatment to give the patient some relief for a few hours afterward, she says.

Introduced commercially in the United States in 2012, bupivacaine liposome injectable suspension (Exparel) is another alternative that has seen some success, Dr Weinberg says. It is indicated for use at the surgical site to produce a post-surgery analgesia, she explains 

“The research has been done with third-molar models in oral surgery,” Dr Weinberg says. “When they’re doing third-molar extractions with this, it doesn’t diffuse around the inside and the tissues [like] when you’re giving it as a regular local anesthetic in a dental cartridge. So, it’s really a good alternative.”

To ensure you are not writing unnecessary prescriptions, Dr Donaldson suggests that clinicians not practice outside their scope. This includes writing prescriptions for friends and family, he says.

“Just because you have the power of the pen and the authority to write for any prescription doesn’t necessarily mean you should. I sometimes refer to that as the Spider-Man principle: With great power, there must also come great responsibility,” Dr Donaldson says. “You’ve worked too long and too hard for your license. Why would you ever put that at risk?”

In addition, Dr Donaldson recommends that dentists and prescribers follow evidence-based guidelines.

“While you might think, ‘It’s just 1 patient. It’s just 1 prescription. What’s the big deal?’ Eventually, this really does start to add up, and it’s a significant challenge to reverse our course.”

Doctor Education and Patient Expectations

Dental schools and state dental boards have also begun to implement guidelines the past few years around opioid prescribing. Between 2016 and 2020, the University of Colorado School of Dental Medicine took actions to reduce the number of opioids prescribed, and these actions resulted in a 5-step plan

Development of a dental pain management protocol

Implementation of the protocol with predoctoral students

Incorporation of the results of a master’s project that determined the actual postoperative pain after periodontal/oral surgical procedures

Development of a favorite electronic prescription list

Creation of patient instructions to allow for information on nonopioid analgesic use after dental procedures to be disseminated to the patient

This process resulted in a 68.8% decrease in opioid prescriptions written as well as a 78.6% decrease of opioid pills over this 3-year period.

“Dental schools have recognized the need for assessing core competencies in pain and anxiety control,” Dr Jeske says. “Certainly, it’s part of our quota accreditation process. And because of that, I believe that most dental schools are now teaching alternatives to opioid analgesics when opioids should not be used or are otherwise contraindicated.”

Things are changing at the state and national levels as well. In 2016, Massachusetts passed a law in an effort to reduce opioid prescription abuse.

 Under this law, students are required to demonstrate how to consider nonopioid treatment options.

Nationally, the Commission on Dental Accreditation, which sets accreditation standards for all dental schools, required all graduates to be proficient in assessing substance use disorder beginning in 2017.

Dr Weinberg says she feels that a lack of proper education and awareness on the dangers of opioids may be why some dentists still prescribe opioids when they may not be clinically necessary.

“I think it’s education and not being aware of the other alternatives that are just as good,” Dr Weinberg says. “Hopefully, the younger dentists or dental students are more aware of the risks associated with those drugs and will adapt.”

Continuing education (CE) has a part to play as well. In fact, 24 states mandate CE that is specific to effective pain management, risk assessment for substance use disorder, proper opioid prescribing, naloxone training, regulatory and law enforcement guidelines, and follow-up care, and 7 of those states define course content in specific terms.

“Just because a medication is over the counter doesn’t mean it’s not as good a pain reliever as the prescribed meds,” Dr Blicher says. “So, we have to have to train our dental workforce to change.”

It is equally important that patients be educated. Many patients are still under the impression that opioids are the best drugs to manage any kind of pain, Dr Pryles explains. Therefore, dentists need to be effective communicators as well.

“Sadly, patients have fallen into some misperceptions as well—that opioids are the best drugs to manage pain,” Dr Pryles says. “My practice counsels patients on the information we have available on these drugs and the fact that they really don’t work to manage acute pain and that we have better alternatives.

“I think a lot of what we need to do now is manage patients’ expectations,” she continues. “Sometimes postop soreness is normal, and we can minimize it with drugs. Sometimes being pain-free is not a realistic expectation. But we can certainly keep people comfortable and do so reasonably well with these over-the-counter meds.”

Many patients believe the misconception that they will get better pain relief from a controlled substance, Dr Jeske says. In fact, “controlled substance” simply refers to a drug’s tolerance and potential for addiction, he explains.

“That creates in the mind of the patient a perception that they will get better pain relief because it is, in fact, a controlled substance,” Dr Jeske says. “Whereas the actual classification as a controlled substance simply refers to the ability of the drug to produce tolerance and dependence leading to addiction. So just because a drug is classified as a controlled substance does not imply, should not imply, that it is pharmacologically superior to a noncontrolled substance.”

With high patient expectations comes the likelihood that patients will request something stronger than Tylenol, Dr Donaldson adds.

As the opioid epidemic rages on, it’s time the profession recognizes the role it has played in the crisis.


Changing the Script: Efforts to Curtail Overprescribing in Dental Practices

Creating anatomically correct and esthetically pleasing dentition requires careful, precise work and attention to detail. Equally important is a technician’s choice of materials, as that can affect strength and esthetics. This is why it is crucial for dental lab technicians to know and understand the properties of a wide variety of the different materials available to them. Here are our top 10 editor’s choice materials for 2021.

Top 10 Editor's Choice Materials 2021

The top new material products of 2021 as chosen by the editors of Dental Lab Products®.

Top 10  Editor’s Choice Materials

Technology has been one of the most notable areas of advancement in modern dentistry. A continuous cycle of new and emerging technologies has enabled clinicians to offer single-day dentistry, reduce pain and increase patient comfort, and perform procedures with more precision than ever before.

Throughout 2021, practices continued to adjust to a world where the risk of COVID-19 was potentially around every corner. Yet technological growth never wavered. This year, the industry saw advancements in x-ray technology, intraoral scanners, and curing lights, to name a few. These technologies and more make up our top 10 technology products of 2021.

Top 10 Technology Products of 2021

The editors of Dental Products Report share a look at the top 10 innovative technology products that went on the market within the last year.

hygienist juggles many demands throughout a regular workday. With keeping infection control pra

ctices top of mind (especially in the era of COVID-19), educating patients on the importance of oral health, and even paying attention to patients’ emotional states or anxieties, the work is nonstop. Maybe that is why some hygienists turned to our more lighthearted content over the course of the year—a chance to unwind after a long day. While still focusing on infection control and professional development, some of this year’s top-performing Modern Hygienist® content came in the form of slideshows on an array of topics, including animal teeth facts, TikTok trends, and Guinness World Records.

Top 5 Editor's Choice Products of 2021

The editors of Dental Products Report® share another look at 5 of the most innovative products launched in the past year.

Throughout the day, dental teams reach for a variety of tools and supplies. These pieces of equipment help dental professionals do their jobs and do them well. This is why it is important to choose the best supplies that fit your practice’s workflow. Our list of the top equipment and supplies of 2021 includes entries from across the spectrum—a handpiece, loupes, and even a wearable HVE tip.

Top 5 Equipment and Supplies

These five new dental equipment and supplies made a big impact on the industry this past year and are worthy of another look here.