NC dentists develop opioid plan

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By Anne Blythe

For some college students, the winter break can be a time for visiting doctors and dentists back home.

Annual physicals, routine dental cleanings or even the extraction of wisdom teeth might be on the calendar.

Teens and young adults who suffered through one of the more excruciating inductions into adulthood  — having their wisdom teeth pulled — might be sent home with a prescription for painkillers.

That can be an introduction to opioids, addictive compounds that contribute to the rising number of drug overdose deaths in North Carolina and nationally.

In 2021, the most recent year for which data are available, more than 3,900 North Carolinians died from drug overdoses, according to the state Department of Health and Human Services. That was a 26 percent increase compared with such fatalities in 2020.

As substance use disorders become more prevalent, the increased presence of the powerful synthetic opioid fentanyl in illicit markets has led to contaminated street drugs and counterfeit pills that are extremely dangerous.

As part of a multi-pronged public health effort to attack the opioid crisis destroying the lives of so many, the state Department of Health and Human Services recently released an updated three-year NC Dental Opioid Action Plan.

The goal is to provide dentists, their patients, staff, families and others with steps they can take to become part of the solution.

“Many people’s first contact with opioids happens when they are prescribed as pain relief after common dental procedures like wisdom tooth removal,” Mark Benton, a DHHS deputy secretary for health, said in a statement when the plan was released in late 2022. “This plan supports the state’s dental providers with actionable steps to both prescribe opioids judiciously and connect their patients to community resources. It’s an integral piece of the department’s work to combat the opioid epidemic.”

The oral health plan is aligned with the state’s broader Opioid and Substance Abuse Action Plan, according to DHHS.

Representatives from the North Carolina Dental Society, specialty dentists and others were instrumental in developing the new goals and policies.

Their recommendations stem from a call to action that state Attorney General Josh Stein and dentists issued in 2019, months before the COVID-19 pandemic took root and overshadowed other public health issues.

The plan includes steps such as prescribing fewer opioids for young people having a “third molar extraction,” namely, having their wisdom teeth out, and offering training at all dental, dental hygiene and dental assistant schools on better pain management techniques.

It encourages “coordination with pain specialists” when prescribing treatment with opioids for patients who have chronic pain in their face, jaw or mouth.

What the ADA says

They have been building upon statements issued on opioids in 2016 and 2018 by the American Dental Association.

The national organization recommends:

The North Carolina plan not only includes the ADA recommendations, it also focuses on what patients and families can do with leftover prescribed opioids. Unused pills stored in medicine cabinets can end up in the wrong hands when they should instead be disposed of through monitored plans that track opioids.

The plan includes a proposal to establish an opioid research agenda, through which North Carolina dental schools and researchers can better inform the state about the impact of the drugs.

Stein commended DHHS and the North Carolina Dental Society for continuing efforts to lower the use of opioids after dental visits, during a recent phone interview with NC Health News.

Prescribe more than British counterparts

A study published in JAMA in 2019 shows that American dentists were among the top prescribers of opioids, second only to family physicians. Compared with their counterparts in England, U.S. dentists were 37 percent more likely to write prescriptions for opioids.

“So much of dental pain has to do with inflammation,” Stein said during his interview. 

If prescribers shifted their focus to the cause of the pain — the inflammation — that might result in a lower reliance on opioids.

Stein, who made opioid reduction a focus of his first term, said he was glad to see the oral health community and state public health workers look for new therapeutic methods to help dental patients after painful procedures.

“There is more work to be done,” Stein said. “A lot of patient education needs to happen.”

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