programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness
COMMON POSTOPERATIVE ORAL SURGICAL SEQUELAE
Common forms of postoperative complications associated with oral surgery include: • Pain.
Clear and factual communication between the dentist and the patient about oral surgery and the postoperative recovery period helps reduce stress for the patient, practitioner, and dental staff. Appropriately conveyed information and instructions can also minimize patients’ fears and the number of after-hours emergency calls to the dental office. To provide accurate consultation, education, and counsel, dental practitioners must be able to recognize common postoperative dentoalveolar sequelae and their recommended treatment or treatments. Pain Pain is a frequently reported side effect associated with oral surgical procedures; it prompts the highest number of after- hours emergency calls received by dental practitioners (Bird & Robinson, 2015). In wisdom tooth extraction, for example, pain after surgery and dry socket are the most common complications (Cho et al., 2017). There are about 2 million visits made to U.S. emergency departments for dental issues each year. A study noted that people treated in the emergency department for dental problems usually have an infection, pain, or both (Sun et al., 2015). As a general rule of practice, postsurgical pain should be treated with the mildest effective medication. Gingival and osseous tissue pain can often be controlled by the peripheral effects of aspirin, acetaminophen, or their derivatives; if necessary, narcotics such as codeine phosphate or its synthetic agents may be required. Narcotic medications such as Synalgos-DC (aspirin/ caffeine/dihydrocodeine) or Vicodin (acetaminophen and hydrocodone) may be better tolerated by patients than products with codeine phosphate (e.g., Tylenol with Codeine No. 3 or Vopac). Oral surgery patients should be instructed to ingest yogurt, cottage cheese, or ginger ale before taking any pain medications in order to prevent nausea. Patients should be instructed to begin taking the pain medication upon returning home from the procedure, rather than waiting for the effect of the local anesthetic to diminish. Preventing a sudden onset of postsurgical pain when the local anesthetic wears off makes pain control easier and more predictable for the patient. Pretreatment analgesics, especially ibuprofen, may also help reduce postoperative pain (Bailey, 2018). The dental practitioner should consider the U.S. Drug Enforcement Administration (DEA) drug schedules if the patient’s pain level warrants an increase from a Schedule III drug (e.g., Synalgos-DC or Tylenol with Codeine No. 3) to a Schedule II drug (e.g., Vicodin or Vicodin ES). The DEA groups prescription drugs into five schedules according to their potential for abuse, with Schedule I drugs having the highest abuse potential (U.S. Department of Justice, n.d.a). For example, a Schedule II drug has a high abuse potential and risk of severe psychic
• Edema. • Trismus. • Infection.
• Ecchymosis. • Hemorrhage. • Nausea. • Dislocation of the condyles. • Fibrinolytic alveolitis (dry socket).
or physical dependence, despite having accepted medical usages. The DEA requires the practitioner to write and sign any prescription for Schedule II drugs (U.S. Department of Justice, n.d.b). A Schedule III drug has a significant abuse potential as well, but it is not as severe as the risks associated with drugs from Schedule II and Schedule I. Because of these decreased risks, the DEA allows a pharmacist to receive a Schedule III drug prescription from a practitioner orally, in writing, or by fax. The opioid crisis is a pandemic that is not restricted to the U.S. More than 16,000 people died in 2020 as a result of prescription opioids, totaling 18% of all opioid deaths (CDC, 2022). Many states have enacted prescription-monitoring programs that collect data about prescriptions for controlled substances such as opioid analgesics (Keith et al., 2018). It is beyond the scope of this discussion to highlight recent laws that limit the duration of an opioid prescription. Each dental clinician who prescribes these medications must be knowledgeable about how these regulations impact their opioid-prescribing practices. Since the combination of ibuprofen and acetaminophen, which is comparable to the opioid medications but does not have the potential for addiction, can provide pain relief, this combination should be considered before prescribing an opioid analgesic. The dosing regimen for dentoalveolar pain control is critical. Acetaminophen and nonsteroidal anti-inflammatory drugs such as ibuprofen are the medications of choice for postsurgical pain. The additive effects of the two medications have repeatedly shown a superior analgesic effect compared with either drug alone. They also have fewer side effects and less abuse potential compared with opioids (Colgate/American Dental Association, 2019). Many practitioners rely on the “2–4–24” mnemonic: “2 drugs, 4 doses, for 24 hours,” such as a combination of 400–600 mg of ibuprofen plus 650-1,000 mg of acetaminophen administered every 6 hours for 24 hours (Cho et al., 2017). Opioid-based analgesics such as hydrocodone and oxycodone should be reserved for the small percentage of dental patients with severe, uncontrolled pain.
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