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Janakiram C, Okunev I, Tranby EP, Fontelo P, Iafolla TJ, Dye BA. Opioids for acute and chronic pain when receiving psychiatric medications. PLoS One 2023; 18:e0286179. [PMID: 37751410 PMCID: PMC10522028 DOI: 10.1371/journal.pone.0286179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/06/2022] [Accepted: 05/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. METHODS AND FINDINGS Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012-2019) for adults aged 21-64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50-64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. CONCLUSIONS Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.
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Affiliation(s)
- Chandrashekar Janakiram
- Amrita School of Dentistry, Amrita Vishwa Vidhyapeetham, Cochin, India
- National Library of Medicine, National Institute of Health, Bethesda, Maryland, United States of America
| | - Ilya Okunev
- Health Data Analytics Institute, Dedham, Massachusetts, United States of America
| | - Eric P. Tranby
- Analytics and Evaluation, Care Quest Institute for Oral Health, Boston, Massachusetts, United States of America
| | - Paul Fontelo
- National Library of Medicine, National Institute of Health, Bethesda, Maryland, United States of America
| | - Timothy J. Iafolla
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bruce A. Dye
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, United States of America
- University of Colorado School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Atanda AJ, Livinski AA, London SD, Boroumand S, Weatherspoon D, Iafolla TJ, Dye BA. Tooth retention, health, and quality of life in older adults: a scoping review. BMC Oral Health 2022; 22:185. [PMID: 35585618 PMCID: PMC9118621 DOI: 10.1186/s12903-022-02210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This scoping review describes the relationship between tooth retention, health, and quality of life in older adults. METHODS Seven databases were searched for English language articles for subjects ≥ 65 y from 1981 to 2021. Exposure was tooth retention (≥ 20), and outcomes were general/systemic health and quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool. RESULTS 140 articles were included, only four were randomized trials. Inter-rater agreement (κ) regarding study inclusion was 0.924. Most were assessed with low risk of bias (n = 103) and of good quality (n = 96). Most studies were conducted in Japan (n = 60) and Europe (n = 51) and only nine in the US. Tooth retention was referred to as "functional dentition" in 132 studies and "shortened dental arch" in 19 studies. Study outcomes were broadly synthesized as (1) cognitive decline/functional dependence, (2) health status/chronic diseases, (3) nutrition, and (4) quality of life. DISCUSSION There is a positive relationship between tooth retention, overall health, and quality of life. Older adults retaining ≥ 20 teeth are less likely to experience poorer health. Having < 20 teeth increases the likelihood for functional dependence and onset of disability, and may affect successful ageing. This review supports the general finding that the more teeth older adults retain as they age, the less likely they are to have adverse health outcomes. However, significant knowledge gaps remain which can limit decision-making affecting successful ageing for many older adults. This review highlights the need to consider, as an important marker of oral health and function, the retention of a functional minimum of a natural dentition, rather than a simple numeric score of missing teeth.
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Affiliation(s)
- Adejare Jay Atanda
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 31 Center Dr., Suite 5B55, Bethesda, MD, USA.
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, OD, National Institutes of Health, Bethesda, MD, USA
| | - Steven D London
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 31 Center Dr., Suite 5B55, Bethesda, MD, USA
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
- School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Shahdokht Boroumand
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 31 Center Dr., Suite 5B55, Bethesda, MD, USA
| | | | - Timothy J Iafolla
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 31 Center Dr., Suite 5B55, Bethesda, MD, USA
| | - Bruce A Dye
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 31 Center Dr., Suite 5B55, Bethesda, MD, USA.
- School of Dental Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
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Ben-Omran MO, Livinski AA, Kopycka-Kedzierawski DT, Boroumand S, Williams D, Weatherspoon DJ, Iafolla TJ, Fontelo P, Dye BA. The use of teledentistry in facilitating oral health for older adults: A scoping review. J Am Dent Assoc 2021; 152:998-1011.e17. [PMID: 34521539 DOI: 10.1016/j.adaj.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Teledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services. TYPES OF STUDIES REVIEWED Nine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria. RESULTS Nineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up. CONCLUSIONS AND PRACTICAL IMPLICATIONS Teledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.
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Chamut S, Boroumand S, Iafolla TJ, Adesanya M, Fazio EM, Dye BA. Self-Reported Dental Visits Among Older Adults Receiving Home- and Community-Based Services. J Appl Gerontol 2020; 40:902-913. [PMID: 32525439 DOI: 10.1177/0733464820925320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate factors associated with infrequent dental use among older adults receiving home- and community-based services. Method: This cross-sectional study analyzed responses from the 2014 National Survey of Older Americans Act participants who received home- and community-based services. Descriptive and multivariable analyses were conducted to examine the association between infrequent dental use and key sociodemographic and health indicators. Results: Infrequent dental use was highest among adults participating in case management and home-delivered meals (63%); the lowest among those participating in congregate meals (41%). Participants who did not complete high school were 2 to 5 times more likely to be infrequent dental users compared to those with educational attainment beyond high school. Discussion: Among older adults receiving home- and community-based services, improving oral health knowledge and health literacy may reduce infrequent dental use.
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Affiliation(s)
| | - Shahdokht Boroumand
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
| | - Timothy J Iafolla
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
| | - Margo Adesanya
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
| | - Elena M Fazio
- National Institutes of Health, National Institute on Aging, Bethesda, MD, USA
| | - Bruce A Dye
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
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Silveira ML, Dye BA, Iafolla TJ, Adesanya MR, Boroumand S, Youngblood ME, Salazar CR, Finlayson TL, Khambaty T, Beaver SM, Isabel Garcia A. Cultural factors and oral health-related quality of life among dentate adults: Hispanic community health study/study of Latinos. Ethn Health 2020; 25:420-435. [PMID: 29343079 PMCID: PMC6148392 DOI: 10.1080/13557858.2018.1427219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 12/15/2017] [Indexed: 06/07/2023]
Abstract
Objective: Research on the relationships between acculturation, ethnic identity, and oral health-related quality of life (OHRQOL) among the U.S. Hispanic/Latino population is sparse. The aim of this study is to examine the association between acculturation, ethnic identity, and OHRQOL among 13,172 adults in the 2008-2011 Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Design: Participants self-reported their acculturation (immigrant generation, birthplace, residence in the U.S., language, and social acculturation), ethnic identity (sense of belonging and pride), and four OHRQOL measures. Key socio-demographic, behavioral, and oral health outcomes were tested as potential confounders.Results: Overall, 57% of individuals experienced poor OHRQOL in at least one of the domains examined. In multivariable analyses, some elements of higher acculturation were associated with greater food restriction and difficulty doing usual jobs/attending school, but not associated with pain or difficulty chewing, tasting, or swallowing. While sense of belonging to one's ethnic group was not associated with poor OHRQOL, low sense of pride was associated with food restriction. Socio-behavioral characteristics were significant effect modifiers.Conclusion: This study contributes to the understanding of the role of Hispanic/Latino's cultural factors in OHRQOL perception and can inform targeted strategies to improve OHRQOL in this diverse population.
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Affiliation(s)
- Marushka L. Silveira
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Bruce A. Dye
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Timothy J. Iafolla
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Margo R. Adesanya
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Shahdokht Boroumand
- National Institute of Dental and Craniofacial Research,
National Institutes of Health, Building 31, Room 5B55, 31 Center Dr, Bethesda, MD
– 20892
| | - Marston E. Youngblood
- University of North Carolina at Chapel Hill, Collaborative
Studies Coordinating Center, 123 West Franklin Street, Suite 450, Chapel Hill, NC
– 27516
| | - Christian R. Salazar
- Department of Epidemiology and Health Promotion, New York
University College of Dentistry, 433 1 Ave, 7 floor, New
York, NY 10010
| | - Tracy L. Finlayson
- San Diego State University, Graduate School of Public
Health, 5500 Campanile Drive, San Diego, CA – 92182-4162
| | - Tasneem Khambaty
- University of Maryland, Baltimore County (UMBC), Department
of Psychology, 1000 Hilltop Circle, Math/Psychology 326, Baltimore, MD 21250
| | - Shirley M Beaver
- University of Illinois at Chicago, College of Dentistry,
Department of Periodontics, 801 S. Paulina street, Chicago, IL – 60077
| | - A. Isabel Garcia
- University of Florida, College of Dentistry, Health Science
Center, Room D4-6B, 1395 Center Drive, Gainesville, FL – 32610
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Janakiram C, Venkitachalam R, Fontelo P, Iafolla TJ, Dye BA. Effectiveness of herbal oral care products in reducing dental plaque & gingivitis - a systematic review and meta-analysis. BMC Complement Med Ther 2020; 20:43. [PMID: 32046707 PMCID: PMC7076867 DOI: 10.1186/s12906-020-2812-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/31/2019] [Indexed: 01/24/2023] Open
Abstract
Background Despite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive. Objective To assess the effectiveness of herbal oral care products compared to conventional products in reducing dental plaque and gingivitis adults. Methods We searched the following databases for Randomised controlled trials (RCTs): MEDLINE Ovid, EMBASE Ovid etc. which yielded 493 trails. Of which 24 RCTs comparing herbal toothpaste or mouth rinse with over the counter toothpaste or mouth rinse in adults aged 18 to 65 years were included. Two authors extracted information and assessed the methodological quality of the included studies using Risk of Bias. Meta-analyses using the random-effects model were conducted for four outcomes for tooth paste and mouth rinse respectively. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals. Results A total of 1597 adults participated in 24 RCT studies. These were classified as herbal toothpaste (HTP) (15 trials, 899 participants) and herbal mouth rinse (HMR) (9 trials, 698 participants) compared with non-herbal toothpaste (NHTP) or non-herbal mouth rinse (NHMR). We found that HTP was superior over NHTP (SMD 1.95, 95% CI (0.97–2.93)) in plaque reduction. The long-term use of NHMR was superior in reduction of dental plaque over HMR (SMD -2.61, 95% (CI 4.42–0.80)). From subgroup analysis it showed that HTP was not superior over fluoride toothpaste (SMD 0.99, 95% CI (0.14–2.13)) in reducing dental plaque. However, HTP was favoured over non-fluoride toothpaste (SMD 4.64, 95% CI (2.23–7.05)). Conclusion For short-term reduction in dental plaque, current evidence suggests that HTP is as effective as compared to NHTP; however, evidence is from low quality studies.
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Affiliation(s)
- Chandrashekar Janakiram
- National Institutes of Health, National Library of Medicine and National Institute of Dental and Craniofacial Research, 31 Center Drive, Suite 4B62, Bethesda, MD, 20892-2190, USA
| | - Ramanarayanan Venkitachalam
- Department of Public Health Dentistry, Amrita Vishwa Vidyapeetham, Amrita School of Dentistry, Kochi, 682041, India
| | - Paul Fontelo
- National Library of Medicine, National Institutes of Health, 8500 Rockville Pike, Bethesda, MD, 20894, USA
| | - Timothy J Iafolla
- National Institute of Dental and Craniofacial Research, 31 Center Drive, Bethesda, MD, 20892-2190, USA
| | - Bruce A Dye
- National Institute of Dental and Craniofacial Research, 31 Center Drive, Bethesda, MD, 20892-2190, USA.
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Janakiram C, Chalmers NI, Fontelo P, Huser V, Mitnik GL, Iafolla TJ, Brow AR, Dye BA. Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid. J Am Dent Assoc 2019; 150:e135-e144. [PMID: 31561765 PMCID: PMC6768087 DOI: 10.1016/j.adaj.2019.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objective of this study was to identify specific factors (sex, race or ethnicity, and health care provider type) associated with patient receipt of an opioid prescription after a dental diagnosis. METHODS The authors used Medicaid claims dated from January 1, 2013, through September 30, 2015, for 13 U.S. states in this study. The authors identified oral health-related conditions by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 520.0 through 529.9. RESULTS During the 2013 through 2015 study period, among the more than 1,008,400 Medicaid patients with a dental diagnosis, 19.8% filled an opioid prescription within 14 days of diagnosis. Female patients were 50% more likely to receive an opioid prescription for pain management of a dental condition than were men (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.49 to 1.52). Non-Hispanic whites and African Americans were approximately twice as likely to receive opioids than were Hispanics (OR, 2.12; 95% CI, 2.05 to 2.19; OR, 1.90; 95% CI, 1.84 to 1.96, respectively). Patients receiving oral health care in an emergency department were more than 7 times more likely to receive an opioid prescription than were patients treated in a dental office (OR, 7.28; 95% CI, 7.13 to 7.43). Patients with a dental condition diagnosed were more than 4 times as likely to receive an opioid from a nurse practitioner as from a dentist (OR, 4.31; 95% CI, 4.19 to 4.44). Opioid use was substantially higher among African American female patients (OR, 2.02; 95% CI, 1.93 to 2.10) and non-Hispanic white female patients (OR, 2.16; 95% CI, 2.07 to 2.24) than among Hispanic female patients. CONCLUSIONS Opioid prescribing patterns differ depending on patient race or ethnicity, sex, and health care provider source in patients with a dental diagnosis in the United States. PRACTICAL IMPLICATIONS Dentists are providing substantially fewer opioid prescriptions compared with their medical colleagues for pain treatment after a dental diagnosis in the Medicaid population. When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.
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Janakiram C, Fontelo P, Huser V, Chalmers NI, Lopez Mitnik G, Brow AR, Iafolla TJ, Dye BA. Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries. Am J Prev Med 2019; 57:365-373. [PMID: 31377093 PMCID: PMC6713282 DOI: 10.1016/j.amepre.2019.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Millions of Americans are affected by acute or chronic pain every year. This study investigates opioid prescription patterns for acute and chronic pain management among U.S. Medicaid patients. METHODS The study used medical and pharmacy claims data obtained from the multistate Truven MarketScan Medicaid Database from 2013 to 2015 for Medicaid patients receiving health care. Medicaid beneficiaries who utilized an outpatient healthcare facility for back pain, neck pain (cervicalgia), joint pain (osteoarthritis and rheumatoid arthritis), orthopedics (simple/closed fractures and muscle strains/sprains), headache (cluster headaches and migraines), dental conditions, or otorhinolaryngologic (otalgia) diagnoses, based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, and received an opioid prescription within 14 days of diagnosis were included in this study. RESULTS There were 5,051,288 patients with 1 of the 7 diagnostic groupings; 18.8% had an opioid prescription filled within 14 days of diagnosis. Orthopedic pain (34.8%) was the primary reason for an opioid prescription, followed by dental conditions (17.3%), back pain (14.0%), and headache (12.9%). Patients receiving an opioid for conditions associated with acute pain management, such as otorhinolaryngologic (OR=1.93, 95% CI=1.85, 2.0), dental (OR=1.50, 95% CI=1.48, 1.53), or orthopedic conditions (OR=1.31, 95% CI=1.29, 1.32), were more likely to receive the prescription from an emergency department provider versus a general practitioner. However, compared with general practitioners, other providers were more likely to prescribe opioids for conditions associated with chronic pain management. CONCLUSIONS More than half of Medicaid beneficiaries receiving an opioid for pain management do so for orthopedic- and dental-related reasons, with emergency department providers more likely to prescribe opioids. Modifications to the guidelines addressing temporary acute pain management practices with opioids would be likely to benefit emergency department providers the most.
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Affiliation(s)
- Chandrashekar Janakiram
- National Library of Medicine, Bethesda, Maryland; National Institute of Dental and Craniofacial Research, Bethesda, Maryland
| | - Paul Fontelo
- National Library of Medicine, Bethesda, Maryland
| | | | - Natalia I Chalmers
- DentaQuest Partnership for Oral Health Advancement, Boston, Massachusetts
| | | | - Avery R Brow
- DentaQuest Partnership for Oral Health Advancement, Boston, Massachusetts
| | - Timothy J Iafolla
- National Institute of Dental and Craniofacial Research, Bethesda, Maryland
| | - Bruce A Dye
- National Institute of Dental and Craniofacial Research, Bethesda, Maryland.
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Janakiram C, Chalmers NI, Fontelo P, Huser V, Lopez Mitnik G, Iafolla TJ, Brow AR, Dye BA. Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid. J Am Dent Assoc 2018; 149:246-255. [PMID: 29599018 PMCID: PMC6152927 DOI: 10.1016/j.adaj.2018.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND The objective of this study was to identify specific factors (sex, race or ethnicity, and health care provider type) associated with patient receipt of an opioid prescription after a dental diagnosis. METHODS The authors used Medicaid claims dated from January 1, 2013, through September 30, 2015, for 13 US states in this study. The authors identified oral health-related conditions by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 520.0 through 529.9. RESULTS During the 2013-2015 study period, among the more than 890,000 Medicaid patients with a dental diagnosis, 23% received an opioid within 14 days of diagnosis. Female patients were 50% more likely to receive an opioid for pain management of a dental condition than were men (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.52 to 1.55). Non-Hispanic whites and African Americans were approximately twice as likely to receive opioids than were Hispanics (OR, 2.11; 95% CI, 2.05 to 2.17 and OR, 1.88; 95% CI, 1.83 to 1.93, respectively). Patients receiving oral health care in an emergency department were nearly 5 times more likely to receive an opioid prescription than were patients treated in a dental office (OR, 4.66; 95% CI, 4.59 to 4.74). Patients with a dental condition diagnosed were nearly 3 times as likely to receive an opioid from a nurse practitioner as from a dentist (OR, 2.64; 95% CI, 2.57 to 2.70). Opioid use was substantially higher among African American female patients (OR, 3.29; 95% CI, 3.18 to 3.40) and non-Hispanic white female patients (OR, 3.24; 95% CI, 3.14 to 3.35) than among Hispanic female patients. CONCLUSIONS Opioid prescribing patterns differ depending on patient race or ethnicity, sex, and health care provider source in patients with a dental diagnosis in the United States. PRACTICAL IMPLICATIONS Dentists are providing substantially less opioid prescriptions compared to their medical colleagues for pain treatment following a dental diagnosis in the Medicaid population. When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.
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Mukherjee A, Livinski AA, Millum J, Chamut S, Boroumand S, Iafolla TJ, Adesanya MR, Dye BA. Informed consent in dental care and research for the older adult population: A systematic review. J Am Dent Assoc 2017; 148:211-220. [PMID: 28065430 DOI: 10.1016/j.adaj.2016.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/19/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue. METHODS The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research. RESULTS The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research. CONCLUSIONS Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research. PRACTICAL IMPLICATIONS This review is the first attempt, to the authors' knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients.
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Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS Data Brief 2015:1-8. [PMID: 25932891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although dental caries has been declining in permanent teeth for many children since the 1960s, previous findings showed caries in primary teeth for preschool children increasing from 24% to 28% between 1988 and 2004. Disparities in caries continue to persist for some race and ethnic groups in the United States. Prevalence of dental sealants--applied to the tooth chewing surfaces to help prevent caries--has also varied among sociodemographic groups. This report describes U.S. youth dental caries and sealant prevalence by race and Hispanic origin for 2011-2012.
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