CDA Essentials 2018 • Volume 5 • Issue 1

29 Issue 1 | 2018 | I ssues and P eople in Scenario F, which I think would have been reasonable to assume.” The study results show that 22%–34% of survey respondents reported they would prescribe opioids for at least 4 scenarios where opioids are not indicated. Overall, general dentists reported prescribing both antibiotics and opioid analgesics more often than endodontists. Are dentists overprescribing? The study authors conclude that “a substantial proportion of dental professionals prescribe opioid analgesics and antibiotics unnecessarily during endodontic procedures,” and note that gender, clinical experience and practice location had no effect on prescribing decisions. So why are so many dentists overprescribing opioids and antibiotics, particularly during a time when antibiotic and opioid stewardship efforts should be producing a decrease? Dr. Buttar says the answers are unclear. “We can only speculate at the possible reasons: pressure from patients for these medications, the pressures of running a busy dental practice that don’t leave enough time for other treatment interventions, and a lack of awareness about when these medications are required.” a Reference 1. Buttar R, Aleksejūnienė J, Shen Y, Coil J. Antibiotic and opioid analgesic prescribing patterns of dentists in Vancouver and endodontic specialists in British Columbia. J Can Dent Assoc. 2017;83:h8 Clinical scenarios presented to survey participants Scenario A A patient calls your office and reports a severe toothache. The pain is constant and worsens when biting on the tooth or touching the tooth. According to the patient, there is no swelling. Circumstances prevent the patient from coming to your office for immediate treatment. Scenario B Same situation as Scenario A except the patient reports minor localized swelling. Scenario C A patient had a deep composite restoration placed 2 weeks ago, but now presents to your office with a severe toothache associated with the same tooth. The tooth is very painful to percussion. When cold is applied to the tooth, it becomes painful and this lingers for 15 s. A radiograph shows no evidence of periapical radiolucency. The diagnosis is irreversible pulpitis. You proceed with root canal treatment and complete it the same day. Scenario D A new patient presents to your office. Radiography reveals an asymptomatic tooth associated with a periapical radiolucency. A deep restoration of the tooth, completed many years ago, approaches the pulp. It does not respond to thermal or electrical pulp testing, and the tooth is diagnosed as necrotic. You proceed with root canal treatment and complete it the same day. Scenario E A patient presents to your office with a severe toothache associated with localized swelling. The tooth nearest the swelling does not respond to thermal or electrical pulp testing. This tooth is diagnosed as necrotic with an acute apical abscess. Radiography shows a large periapical radiolucency. You initiate root canal treatment that same day. You full instrument all of the canals, obtaining some drainage through the canals and plan to complete root canal treatment at another appointment. Scenario F You recently completed root canal treatment on a patient’s tooth. After 3 days, the patient returns in severe pain with a visible swelling in the gingival area of the tooth that was treated. Your final radiograph shows no obvious deficiencies in the root canal filling. Scenario G The patient in scenario F returns again 2 days later with unbearable pain and swelling that has progressed significantly. The skin overlying the area of the treated tooth is red and warm.