Dentistry ups students' training in pain-relief prescriptionsThe school's third- and fourth-year clerkships are placing more emphasis on opioids' risks and dosages, and on alternative medications
The University of Washington’s School of Dentistry is acutely aware of the opioid crisis and the role dentists must play in terms of more stringent prescribing guidelines and other measures.
Dr. Rolf Christiansen, who teaches this topic, said the school covers pharmacology extensively, with good prescribing practices emphasized in the third and fourth years, when students treat live patients.
Third-year students undertake a series of six- or 12-week clerkships designed to provide intensive exposure to core skills of general dentistry. The oral and maxillofacial surgery clerkship and the oral medicine clerkship have centrally addressed prescribing skills and behaviors, Christiansen said. The oral medicine clerkship, which he directs, has also added 10 hours of instruction on antibiotics and pain relievers, and models of good prescribing practices have been incorporated into 20 hours of existing case problem-solving.
The school emphasizes the use of non-steroidal anti-inflammatories and acetaminophen for pain management, he said. Where opioids are warranted, students are told that clinicians should prescribe the lowest effective dose of opioids and no greater quantity than needed for the expected duration of pain severe enough to require opioids.
Washington state’s Prescription Monitoring Program database is used regularly during patient care. At every clinical station, faculty and students can access this information about prescribed opioids and controlled substances. The school’s clinical providers also routinely consult with other providers, including pain-management specialists.
“Opioids do have a place in treating dental pain, but they shouldn’t be a routine part of the prescribing protocol,” said Dr. Joel Berg, the school’s dean. “We should be asking the necessary questions of the patient before considering their use, and we should also determine whether other pain relievers, such as ibuprofen, can work just as well. In many cases, they can.”
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