CDA Essentials 2019 • Volume 6 • Issue 6

Ending the routine prescription of opioids after third molar surgery is supported by the CAHD, which recommends avoiding use of opioids for post-operative dental pain until an optimized dose of NSAIDs/ acetaminophen has been used. According to Dr. Aaron Burry, CDA associate director of professional affairs, the thinking about when opioids are needed to manage dental pain has changed since the time of his training. “Opioids were more routinely prescribed, particularly after third molar extractions, when I started practice,” he says. “Much of my practice experience has been in public clinics where some patients have substance use issues and opioids are not prescribed in these settings. As a result, it’s been 20 years since I’ve prescribed an opiate; now I provide over-the-counter NSAIDs after a discussion with patients about post-operative pain, including their previous experiences and concerns,” says Dr. Burry. Alice Watt, a pharmacist and medication safety specialist at ISMP Canada said ISMP Canada was motivated to produce a resource for patients after reading a story by Amy Ma, a patient advocate for Choosing Wisely Canada. Her story describes the steps she had to take to get a non-opioid pain medication for her 16-year-old son after his third molars were removed. You can read Amy’s story at: choosingwiselycanada.org/perspective/opioids-after-wisdom-teeth In Canada, data from some provinces 1–3 suggest that dentists prescribe a small percentage of all dispensed opioids compared to other prescribers. Although it’s not clear how commonly opioids are prescribed after wisdom teeth surgery, at least one study from British Columbia suggests that opioids are unnecessarily prescribed for endodontic procedures. 4 The ISMP Canada patient resource is available at : ismp-canada.org/ opioid_stewardship a References 1. OpioidprescribingbyOntariodentists,2014-2016. RoyalCollegeofDentalSurgeonsofOntario.2018. 2. JimohKO,MatthewsDC,BrillantM,Sketris I .PatternofOpioidAnalgesicPrescription forAdultsbyDentists in NovaScotia,Canada . JDRClinTransRes. 2018;Vol.3,2:pp.203-211. 3. FalkJ, FriesenKJ , MagnussonC , SchrothRJ, BugdenS. Opioidprescribingbydentists inManitoba,Canada:A longitudinalanalysis. JAmDentAssoc. 2019;150(2):122-29. 4. ButtarR, AleksejūnienėJ ,ShenY,CoilJ.Antibioticandopioidanalgesicprescribingpatternsofdentists in Vancouverandendodonticspecialists inBritishColumbia. JCanDentAssoc. 2017;83:h8. Ending the routine prescription of opioids after third molar surgery is supported by the CAHD, which recommends avoiding use of opioids for post-operative dental pain until an optimized dose of NSAIDs/acetaminophen has been used. ➜ ChoosingWisely inDentistry CDA has officially partnered with Choosing Wisely Canada, joining its national campaign to help clinicians and patients engage in conversations about unnecessary tests, treatments and procedures. According to the Canadian Institute of Health Information, up to 30% of tests, treatments and procedures performed in Canada are potentially unnecessary. In partnership with professional societies and associations representing different clinical specialties, Choosing Wisely Canada develops lists of “Things Clinicians and Patients Should Question.” In dentistry, common areas of overuse have been highlighted by the Canadian Association of Hospital Dentists (CAHD). In its Choosing Wisely list, five of eight recommendations cover overprescribed medications by dentists. This includes the recommendation to not use opioids for post-operative dental pain until an optimized dose of NSAIDs/ acetaminophen has been used. To read Eight Things Dentists and Patients Should Question , the Choosing Wisely Canada recommendations developed in partnership with the CAHD, visit choosingwiselycanada.org/ hospital-dentistry N ews and E vents 18 | 2019 | Issue 6