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Farooqi OA, Bruhn WE, Lecholop MK, Velasquez-Plata D, Maloney JG, Rizwi S, Templeton RB, Goerig A, Hezkial C, Novince CM, Zieman MT, Lotesto AMN, Makary MA. Opioid guidelines for common dental surgical procedures: a multidisciplinary panel consensus. Int J Oral Maxillofac Surg 2020; 49:397-402. [PMID: 31611048 PMCID: PMC8771805 DOI: 10.1016/j.ijom.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/13/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023]
Abstract
One in 16 patients prescribed opioids after a surgical procedure will become a long-term user. The lack of procedure-specific guidelines after common dental procedures contributes to the opioid overprescribing problem. We convened a multidisciplinary panel to develop consensus recommendations for opioid prescribing after common dental procedures. We used a three-step modified Delphi method to develop a consensus recommendation for outpatient opioid prescribing for 14 common dental procedures. The multi-institution, multidisciplinary panel represented seven relevant stakeholder groups (oral surgeons, periodontists, endodontists, general dentists, general surgeons, oral surgery residents, and oral surgery patients). The panel determined the minimum and maximum number of opioid tablets a clinician should consider prescribing. For all 14 surgical procedures, ibuprofen was recommended as initial therapy. The maximum number of opioid tablets recommended varied by procedure (overall median = 5 tablets, range = 0-15 tablets). Zero opioid tablets were recommended as the maximum number for six of 14 (43%) procedures, one to 10 opioid tablets was the maximum for four of 14 (27%) procedures, and 11-15 tablets was the maximum for four of 14 (27%) procedures. Procedure-specific prescribing recommendations may help provide guidance to clinicians and help address the opioid overprescribing problem.
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Affiliation(s)
- O A Farooqi
- Department of Veteran Affairs, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - W E Bruhn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M K Lecholop
- Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - S Rizwi
- Dow International Medical College, Dow University of Health Sciences
| | | | - A Goerig
- Department of Orofacial Pain, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - C Hezkial
- Department of Orofacial Pain, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - C M Novince
- Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - M T Zieman
- Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - A M N Lotesto
- Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - M A Makary
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Schiffman EL, Look JO, Hodges JS, Swift JQ, Decker KL, Hathaway KM, Templeton RB, Fricton JR. Randomized effectiveness study of four therapeutic strategies for TMJ closed lock. J Dent Res 2007; 86:58-63. [PMID: 17189464 PMCID: PMC2278036 DOI: 10.1177/154405910708600109] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p > or = 0.33) or SSI (p > or = 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.
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Affiliation(s)
- E L Schiffman
- University of Minnesota School of Dentistry, Department of Diagnostic and Biological Sciences, Minneapolis, MN 55455, USA.
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