For managing acute dental pain, there is an urgent need to formalize the evidence-based alternatives to opioids in a clinical practice guideline, disseminate the guideline, and facilitate its uptake by providers through an implementation strategy. The long-term goal of our program of research is to increase providers? uptake of evidence-based approaches to clinical care. Our objectives are to develop a clinical practice guideline for the management of acute dental pain, develop and deploy dissemination and implementation strategies, and evaluate the effectiveness of those strategies in changing provider prescribing behavior. The rationale for the proposed project is that once it has been completed, the field will have a standard of care, patients will receive safe and effective relief from acute dental pain, and the risk of opioid diversion, opioid use disorder, and overdose will be reduced. To address these needs and attain our objectives, we will pursue these specific aims.
Aim 1 : Develop an evidence-based clinical practice guideline for the management of acute dental pain (surgical and non-surgical).
Aim 2 : Develop a dissemination and implementation plan to increase uptake of the clinical practice guideline.
Aim 3 : Evaluate the reach and impact of the dissemination and implementation strategies. With the achievement of these aims, we expect to attain the following outcomes. First, we will create an evidence-based clinical practice guideline for the management of acute dental pain and the tools to help dentists and other health care providers incorporate this guideline into routine practice as part of shared decision making. Second, we will establish a dissemination and implementation plan to facilitate the adoption and sustained use of the clinical practice guideline. Third, using the RE-AIM framework for evaluation, we will determine the effectiveness of the dissemination plan and evaluate the ability of the implementation plan to change provider prescribing patterns compared with baseline and control sites. Collectively, we will have an important overall impact by reducing the risk of opioid diversion, opioid use disorder, and overdose. This contribution will be significant because in the absence of restrictive formularies, collectively the outcomes define the remaining approach to reducing providers? reliance on opioids to manage acute dental pain. With the reduction in providers? use of opioids to manage acute dental pain, benefits to morbidity and mortality will accrue. The proposed project is innovative because we are using a public-private partnership including the state dental directors to develop the guidelines, and we are engaging citizen stakeholders in a deliberative process to inform the guideline development. In addition, we are using a prescription dataset capturing 92% of all outpatient prescriptions nationally for our patient-level analysis to measure change in prescribing in the highest prescribing areas.
The proposed research is relevant to public health because it focuses on establishing a standard of care for the management of acute dental pain. Once a clinical practice guideline has been developed, providers will have a standard of care, patients will receive safe and effective relief from acute dental pain, and the risk of opioid diversion, opioid use disorder, and overdose will be reduced. The project is relevant to the FDA?s mission of enhancing public health and minimizing the risk of harm associated with the products it regulates.
