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Case/Article Review 5


Use of opioids to soothe pain from pulled teeth could be reduced or even eliminated, according to researchers at the University of Michigan. More than 325 dental patients who had teeth pulled were asked to rate their pain and satisfaction within six months of extraction. Roughly half of the study's patients who had surgical extraction and 39% who had routine extraction were prescribed opioids. Researchers compared the pain and satisfaction of those who used opioids to those who didn't.

"I feel like the most important finding is that patient satisfaction with pain management was no different between the opioid group and non-opioid group, and it didn't make a difference whether it was surgical or routine extraction," said study co-author Romesh Nalliah, clinical professor and associate dean for patient services at the U-M School of Dentistry. Surprisingly, patients in the opioid group actually reported worse pain than the non-opioid group for both types of extractions, Nalliah said.

The researchers also found that roughly half of the opioids prescribed remained unused in both surgical and nonsurgical extractions. This could put patients or their loved ones at risk of future misuse of opioids if leftover pills are not disposed of properly. "These data support the Michigan OPEN prescribing recommendations calling for no opioids for the majority of patients after dental extractions, including wisdom teeth extraction," Nalliah added.

"Dentists are torn between wanting to satisfy patients and grow business and limiting their opioid prescribing in light of the current crisis. I think it's an extremely liberating finding for dentists who can worry more about the most effective pain relief rather than overprescribing for opioids."
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Dentists account for about 6% to 6.5% of U.S. opioid prescriptions -- a relatively small amount. But the study notes that dentists are among the most common prescribers for minors, and for many patients, dental opioid prescriptions are their first exposure.
 
Outline the main issues raised.

(Reference: Adapted from: https://www.sciencedaily.com/releases/2020/03/200313180825.htm) 
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Example Candidate Response
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Researchers at the University of Michigan have found that opioids are over-prescribed in dentistry, questioning than 325 dental patients who had their teeth pulled were asked to rate their pain within six months of extraction.

The fact that they found no difference in satisfaction of pain management between the opioid group and non-opioid group is concerning in context of the huge rate of prescription of opioids in America. In fact, pain was found to be higher in the opioid group than non-opioid, potentially showing a truly detrimental over-reliance on opioid prescription by American healthcare workers that is having a negative effect on patient health.

Additionally, roughly half of opioids went unused - creating a possible risk for family if they were not disposed of properly. The difficulty for dentists in America is that they must satisfy their patients in order to receive funding - yet over prescribing opioids benefits no one and may harm many.

Dr Nalliah, co-author of the study, believes these findings will make it easier for dentists to refuse patients opioids in this situation.
​
This is seemingly crucial to a resolution, as patients must be educated in this situation in order to lower prescription rates. 

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