Myth busters: Dental assistants and their role in the opioid crisis

Aug. 23, 2019
It's becoming well known among dental professionals that they are contributing to the opioid crisis. How can dental assistants play a role in changing patient dependence on these painkillers?

As a dental assistant, there is nothing I can do to help fight the war against opioids. Right? Wrong!

Dentists have commonly prescribed opioids to help with pain following tooth extractions and other procedures. Since 2016, more than 48,000 deaths have been attributed to substance overdoses related to opioids. Dentists have been identified as among the leading prescribers of opioids.1 So, what can you do? You’re just a dental assistant, right? Wrong again!

Here are the facts

It is estimated that more than two million Americans abuse prescription drugs. From 2001 to 2011, the number of people seeking treatment for prescription painkillers increased by five times. It is estimated that opioid overdoses are at a level now reaching proportions as high as the HIV epidemic did in the 1980s. Studies show that one in eight high school students report using prescription drugs for recreational use.1

Dental assistants spend more time with patients than with any other team members. We have the opportunity to learn more, listen better, and be more proactive when it comes to patient care. That certainly includes being at the forefront of the drug crisis.

Dentists make up approximately 12% of the opioid prescriptions written annually.2 Children can be introduced to opioids early, for example, when they have a wisdom tooth removed. Among adolescents, approximately half of their opioid prescriptions are written by dentists—including oral surgeons—which account for 31% of adolescents’ first exposure to opioids. America’s youth are impressionable, and evidence suggests that this introduction to opioids can lead to misuse and/or substance abuse just a short time after the drugs are prescribed.2 Dental practice teams typically do not offer risk screening or patient education when they prescribe opioids.

This is exactly where dental assistants come in! Aside from infection control, patient education is one of the most important things dental assistants do. It is critical that we understand the vital role we play in mitigating the risks associated with opioids. When dealing with young patients and while following the rules of HIPAA, we should do what we can to educate patients, and the parents of young patients, about the dangers of opioid misuse.

We know that some dental procedures cause significant discomfort in patients, usually after the numbness wears off. This often occurs after office hours. While prescribing opioids in dentistry is common, studies have shown that nonsteroidal, anti-inflammatory drugs (NSAIDs) are effective in managing pain, and these usually cause significantly fewer adverse side effects when compared with opioids. Research has shown that the combination of acetaminophen and ibuprofen taken at regular intervals has proven to be more effective than opioids.1 This practice has been adopted by my dental office and many other practices. It is important to explain this combination of drugs to your patients and why it is better than opioids.

Know your patients

It’s important to identify patients who may be at risk for misuse of medications. This is the responsibility of every health-care provider and should be part of patients’ complete medical histories, along with assessments of alcohol, tobacco, prescription medication, and illicit drug use, a history of current or chronic pain, and a history of mental health treatment.

Dental health-care providers are falling short when it comes to identifying patients at high risk of opioid misuse. While a written assessment is important, a verbal review of risk factors and health conditions associated with drug misuse and abuse can be conducted by any member of the dental team, and that includes dental assistants! Talk to your patients, and really listen to their answers. Watch for body language when you ask about substance abuse. Are they uneasy? Do you have a patient calling the office and asking for more? Even though patients must now have a written prescription, many will still call and ask. Documenting these calls is part of the assessment and a very important part of each patient’s record.

At least opioid abuse is now out in the open and something health-care professionals are talking about it, but that’s not enough. We have to do more to educate our patients and to help save their lives. This starts with you. If you know something, if you hear anything, or if you’re concerned about possible misuse, then be proactive. You have the responsibility to let your dentist know.

In the time it has taken you to read this, approximately four Americans have died of an opioid overdose. Now, let that sink in.


1. https://www.adea.org/policy/white-papers/preventing-opioid-prescription-drug-misuse.aspx

2. https://www.dentalcare.com/en-us/professional-education/ce-courses/ce560/introduction


It’s OK to carry my cell phone through the workday
Waterline contamination in dental offices
Acrylic or gel fingernails at work

Tija Hunter, CDA, EFDA, CDIA, MADAA, is the office manager and chairside assistant to Dr. Eric Hurtte of O’Fallon, Missouri. She is a member of the American Dental Assistants Association (ADAA), where she holds the honor of Master and sits on three national counsels. She is also the Illinois Dental Assistants Association vice president. She is founder of the Dental Assistants Study Club of St. Louis and St. Louis Dental Office Managers Study Club. She is the director of the Dental Careers Institute, with five locations in the US. Tija is also the author of six CE study courses. She is a national speaker and a certified trainer in nitrous oxide in several states. She can be reached at [email protected].