Systematic literature review of emergency department physicians’ confidence to treat dental pain and the frequency with which they prescribe pain medications: Considerations for improved outcomes.
DOI:
https://doi.org/10.5195/d3000.2019.85Keywords:
opioids, oral surgery, emergency roomAbstract
Opioid analgesics, when taken as prescribed, are effective therapeutic options that provide pain relief for moderate to severe pain. The use of opioids in the treatment of pain has been increasing in the U.S. at an alarming rate, possibly contributing to the simultaneous rise in opioid abuse. Emergency departments play a major role in managing patients who present in pain, with approximately 10% of all opioid analgesic prescriptions written in hospital emergency departments. It is estimated that dental pain patients represent between 0.3-4% of the overall patient emergency department workload. Yet, the literature suggests that many of these physicians may not have sufficient training in handling dentofacial emergencies. The goal of this study was to systematically review the available literature on the topics of: 1) emergency department physicians’ training related to treating dental pain patients, and 2) the frequency in which they prescribe opioid medications to these patients. Methods: A systematic literature review was conducted among publications from 1985-2014 in the databases PubMed, Ovid, and Science Citation Index. The following search terms were used in this systematic literature review in order to identify the available literature of interest: “opioid and dental and emergency departments,” “dental pain and drug abuse,” “ER physicians and dental pain,” “ER physicians and drug abuse,” and “dental pain and emergency departments.” Publications in any language or country were considered, as well as editorials and commentaries. Findings: A total of 769 publications were identified. Seventeen publications met the criteria for inclusion. Eight studies commented on the emergency department physicians’ perceived “lack of training” in handling dentofacial emergencies and found that the majority of this group did not feel comfortable in managing dental patients. Nine studies assessed the frequency in which physicians prescribe pain medications to dental patients. Within these 9 studies, 5 specifically reported that between 29.6% and 81% of dental patients treated, received an “opioid” or a “narcotic” upon discharge. The remaining 4 studies in this group instead used non-specific terms that included “prescription medications,” “analgesics,” “pain medicine,” and “pharmacotherapy” to describe their findings and did not particularly report opioid prescribing trends. Of those publications rejected, 9 addressed the topic of dental pain patients presenting to non-dental providers, but did not include data that met the criteria related to emergency department prescribing frequency or physician training. Conclusions: This review of the literature suggests that emergency department physicians’ training level in treating dentofacial pain is less than ideal. It also confirms that individuals presenting to emergency departments with dental pain are a subset of the population of patients who are prescribed opioids as an analgesic. Coupling these results with the increased use of opioids in this country, dentists are in a key position to collaborate with emergency department physicians to help positively affect change. To further justify this approach, research agendas must carefully monitor prescribing patterns for dentofacial pain in the emergency department that are specific to opioid use, carefully excluding other non-narcotic analgesics. Should comparable outcomes of data related to the same topic in other non-dental settings exist, additional areas in medicine that may benefit from this partnership may also be identified. Moving forward, this interprofessional team approach may include a presence in medical school and residency program curricula so that alternative treatment options for addressing dental pain patients can be presented that consider the increased prescribing trends of opioids.
References
Multidisciplinary intervention decreases the use of opioid medication discharge packs from 2 urban EDs. Gugelmann H, Shofer FS, Meisel ZF, Perrone J.Am J Emerg Med. 2013 Sep;31(9):1343-8. doi: 10.1016/j.ajem.2013.06.002
Prevention of prescription opi-oid abuse: the role of the den-tist.
Denisco RC, Kenna GA, O'Neil MG, Kulich RJ, Moore PA, Kane WT, Mehta NR, Hersh EV, Katz NP. J Am Dent Assoc. 2011 Jul;142(7):800-10.
Policy Impact: Prescription Painkiller Overdoses. Centers for Disease Control and Preven-tion. Policy impact: prescription painkiller overdoses. http://www.cdc.gov/homeandrecreationalsafety/rxbrief/ Ac-cessed August 4, 2014.
National Institute of Drug Abuse. Topics in brief: prescrip-tion drug abuse. http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse. Accessed August 4, 2014.
Centers for Disease Control and Prevention. Addressing pre-scription drug abuse in the United States. 2013;1-36. http://www.cdc.gov/HomeandRecreationalSafe-ty/pdf/HHS_Prescription_Drug_Abuse_Report_09.2013.pdf. Ac-cessed August 4, 2014.
Medications prescribed in emergency departments for nontraumatic dental condition visits in the United States. Okunseri C, Okunseri E, Thorpe JM, Xiang Q, Szabo A. Med Care. 2012 Jun;50(6):508-12. doi: 10.1097/MLR.0b013e318245a575.
Managing dental emergencies: a descriptive study of the effects of a multimodal educational in-tervention for primary care providers at six months. Skape-tis T, Gerzina T, Hu W. BMC Med Educ. 2012 Oct 30;12:103. doi: 10.1186/1472-6920-12-103.
Prescription of opioid and nonopioid analgesics for dental care in emergency departments: Findings from the National Hospital Ambulatory Medical Care Survey. Okunseri C, Okun-seri E, Xiang Q, Thorpe JM, Szabo A. J Public Health Dent. 2014 Fall;74(4):283-92. doi: 10.1111/jphd.12055.
The attitudes and awareness of emergency department (ED) physicians towards the man-agement of common dentofacial emergencies. Trivedy C, Kodate N, Ross A, Al-Rawi H, Jaiganesh T, Harris T, Anderson JE. Dent Traumatol. 2012 Apr;28(2):121-6. doi: 10.1111/j.1600-9657.2011.01050.x.
Expanding the physician's role in addressing the oral health of adults. Cohen LA. Am J Public Health. 2013 Mar;103(3):408-12. doi: 10.2105/AJPH.2012.300990
[11] Reducing the burden of dental patients on the busy hos-pital emergency department. McCormick AP, Abubaker AO, Laskin DM, Gonzales MS, Gar-land S. J Oral Maxillofac Surg. 2013 Mar;71(3):475-8. doi: 10.1016/j.joms.2012.08.023
Dental complaints in emergency departments: a national per-spective. Lewis C, Lynch H, Johnston B. Ann Emerg Med. 2003 Jul;42(1):93-9.
Effect of education and guide-lines for treatment of uncompli-cated dental pain on patient and provider behavior. Ma M, Lind-sell CJ, Jauch EC, Pancioli AM. Ann Emerg Med. 2004 Oct;44(4):323-9.
Emergency department visits for dental care of nontraumatic origin. Quiñonez C, Gibson D, Jokovic A, Locker D. Community Dent Oral Epidemiol. 2009 Aug;37(4):366-71. doi: 10.1111/j.1600-0528.2009.00476.x.
Visiting the emergency depart-ment for dental problems: trends in utilization, 2001 to 2008. Lee HH, Lewis CW, Saltz-man B, Starks H. Am J Public Health. 2012 Nov;102(11):e77-83. doi: 10.2105/AJPH.2012.300965. Emergency dental anesthesia blocks. Daymude ML, Hilliard MW. Adv Emerg Nurs J. 2007;29(2):172-179.
Emergency department bane--dental pain used to obtain nar-cotics. Hupp JR. J Oral Maxillofac Surg. 2013 Dec;71(12):2009-10. doi: 10.1016/j.joms.2013.09.028
Doctor, my tooth hurts: the costs of incomplete dental care in the emergency room. Davis EE, Deinard AS, Maïga EW. J Public Health Dent. 2010 Sum-mer;70(3):205-10. doi: 10.1111/j.1752-7325.2010.00166.x.
The root of the problem. Mckenna M. Ann Emerg Med. 2010;55(6):17-19.
Dental emergencies presenting to a general hospital emergency department in Hobart, Australia. Verma S, Chambers I. Aust Dent J. 2014 Sep;59(3):329-33. doi: 10.1111/adj.12202.
Managing dental pain in the emergency department: dental disparities with practice impli-cations. Dowling Evans D, Gis-ness C. Adv Emerg Nurs J. 2013 Apr-Jun;35(2):95-102. doi: 10.1097/TME.0b013e31828f701e.
Cohen L, Bonito A, Eicheldinger C et al. Comparison of patient visits to emergency depart-ments, physician offices, and dental offices for dental prob-lems and injuries. J Public Health Dent. 2011;71:13-22.
Visits to non-dentist health care providers for dental problems. Cohen LA, Manski RJ. Fam Med. 2006 Sep;38(8):556-64.
Pain and prescription monitor-ing programs in the emergency department. Todd KH. Ann Emerg Med. 2010 Jul;56(1):24-6. doi: 10.1016/j.annemergmed.2010.02.025.
Open wide! Dental settings are an untapped resource for sub-stance misuse screening and brief intervention. McRee B. Ad-diction. 2012 Jul;107(7):1197-8. doi: 10.1111/j.1360-0443.2012.03777.x.
Dental visits to a North Carolina emergency department: a pain-ful problem. Hocker MB, Villani JJ, Borawski JB, Evans CS, Nel-son SM, Gerardo CJ, Limkakeng AT. N C Med J. 2012 Sep-Oct;73(5):346-51.
Dentistry in the emergency de-partment. Gibson DE, Verono AA. J Emerg Med. 1987;5(1):35-44.
Common dental emergencies. Evaluation and management for emergency physicians. Klokkevold P. Emerg Med Clin North Am. 1989 Feb;7(1):29-63.
Community-wide emergency department visits by patients suspected of drug-seeking be-havior. Zechnich AD, Hedges JR. Acad Emerg Med. 1996 Apr;3(4):312-7.
Teaching oral health in U.S. medical schools: results of a na-tional survey. Ferullo A, Silk H, Savageau JA. Acad Med. 2011 Feb;86(2):226-30. doi: 10.1097/ACM.0b013e3182045a51
A performance improvement prescribing guideline reduces opioid prescriptions for emer-gency department dental pain patients. Fox TR, Li J, Stevens S, Tippie T. Ann Emerg Med. 2013 Sep;62(3):237-40. doi: 10.1016/j.annemergmed.2012.11.020
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