CE Questions The answer sheet and further instructions are located on the tear-out card that appears on page 37, or take the test online at dimensionsofdentalhygiene.com. 1. In 2007, oral health professionals wrote what percentage of all immediate-release opioid prescriptions? A. 10.0% B. 12.2% C. 22.2% D. 32.2% 2. Sixty percent to 70% of opioid prescriptions written by oral health professionals were dispensed by which specialist? A. Dental hygienists B. Prosthodontists C. Oral and maxillofacial surgeons D. Periodontists 3. It is estimated that what percentage of opioid prescriptions end up being used recreationally? A. 15% B. 25% C. 35% D. 45% 4. Several randomized controlled trials found that combining nonsteroidal anti-inflammatory drugs and acetaminophen may provide better analgesia than ibuprofen or acetaminophen alone. True False 5. Moderate pain can be expected following which procedure? A. Simple root canal B. Surgical extractions C. Restorations D. Complex oral maxillofacial surgery 6. Which of the following is the maximum daily dose for ibuprofen? A. 1,200 mg B. 2,200 mg C. 3,200 mg D. 4,200 mg 7. The combination of ibuprofen and acetaminophen became commercially available in what year? A. 2020 B. 2021 C. 2022 D. 2023 8. The use of bupivacaine in the dental setting, especially during the removal of third molars, can provide pain control for several hours following the procedure. True False 9. Sublingual sufentanil was found to have an onset of 15 minutes and a duration of up to 12 hours, with only what percentage of patients reporting ineffective analgesia? A. 1% B. 2% C. 3% D. 4% 10. Opioids are indicated as first-line analgesics for mild to moderate pain following routine dental procedures. True False SECTION 1 SECTION 2 SECTION 3 6 and may not be appropriate for patients with special needs due to the risk of prolonged numbness and self-injury. However, liposomal bupivacaine offers promising potential for post- treatment pain control Sublingual Sufentanil Tablets Sublingual sufentanil tablets offer another novel approach to pain management with possible appli- cations in dental surgery. Sufentanil is a synthetic opioid that acts on the mu opioid receptors, result- ing in potent analgesia. Compared to other opioids, such as morphine or hydromorphone, sufentanil has no clinically relevant metabolites and its dosage does not need to be adjusted for age. While sublingual sufentanil is still an opioid and carries abuse potential, it is not indicated for self-administration. Rather, it is administered in-office by a clinician using a single-dose applicator, thus removing the potential for patient self-dosing outside of healthcare settings.10 Clinical studies demonstrate high efficacy following abdominal and orthopedic surgeries, including patients with complex medical histories. Sublingual sufentanil was found to have an onset of 15 minutes and a duration of up to 12 hours, with only 3% of patients reporting ineffective analgesia.10 Another study found similar results up to 12 hours, with only 3.7% of patients taking sublingual sufen- tanil requiring rescue analgesia, compared to 18.5% of patients on a placebo.11 No clinically rel- evant adverse outcomes were reported.11 While the existing studies demonstrate the promising application in general surgery, there have yet to be studies evaluating the efficacy of sublingual sufentanil on post-operative dental pain. However, sublingual sufentanil tablets have good potential for clinical use following significant oral and maxillofacial surgeries — although further research is needed to justify its introduction into dental practice. Summary The evidence is clear that opioids are not indicated as first-line analgesics for mild to moderate pain following routine dental procedures. Opioid-sparing strategies are highly effective when using alternatives such as NSAIDs alone or in combination with acetaminophen. Opioid analgesia is effective in controlling postoperative pain, but poses risks for dependence and side effects, such as nausea, constipation, and drowsiness. Therefore, opioids should be reserved for complex dental surgery as needed for breakthrough pain. Clinicians may also con- sider a multimodal approach with use of long-acting local anesthetics to delay the onset of post- procedural pain. Alternatives, such as liposomal bupivacaine and sublingual sufentanil, have great potential in controlling post-operative discomfort. Liposomal bupivacaine is a time-released local anesthetic that, when infiltrated into the surgical site, can produce several days of pain relief. In addition, sub- lingual sufentanil tablets may be a future option for dentists to provide patients with the powerful analgesia of an opioid — but with few of the side effects. Sublingual sufentanil tablets have the benefit of being delivered postsurgically by a healthcare professional, avoiding the possibility of self-dosing outside of the dental office. With more dental- specific studies, new management strategies may soon be available for oral health professionals to consider. The references that accompany this article appear with the web version at: dimensionsofdentalhygiene.com. D MARINAVLADIVOSTOK, CC0, VIA WIKIMEDIA COMMONS dimensionsofdentalhygiene.com July/August 2023 • Dimensions OF DENTAL HYGIENE 45 FIGURE 1. MODEL OF A BUPIVACAINE MOLECULE. AN INJECTABLE LOCAL ANESTHETIC, LIPOSOMAL BUPIVACAINE HOLDS PROMISE AS A NOVEL ALTERNATIVE FOR LONG-LASTING POST-OPERATIVE PAIN MANAGEMENT.
