Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender 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 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.
INTRODUCTION
While pain has both physiological and psychological components, an experience of poorly managed pain related to dentistry can lead patients to avoid or postpone treatment, making these patients more difficult to treat and less likely to comply with prescribed regimens. Oral medications administered postoperatively that reduce pain improve clinical outcomes, making them an integral part of dental practice. Analgesic medications in dentistry are indicated for the relief of acute pain, postoperative pain, and chronic pain, and for controlling adjunctive intraoperative pain (pain not associated with the dental procedure). In addition, these medications can be given preoperatively (preemptively) to mitigate both postoperative pain and postoperative pain medication requirements. Most postoperative dental pain is acute in nature and typically accompanied by tissue injury or inflammation. While this pain can resolve spontaneously once the underlying cause (e.g., inflamed pulp, carious lesion, or abscessed gingiva) is definitively treated, a pharmacological approach to pain management may be considered the standard of care. Acetaminophen and the nonsteroidal anti-inflammatory drugs (NSAIDs) are the medications of choice for postoperative dental pain. NSAIDs inhibit the activity of cyclooxygenase (COX) enzymes, and thereby inhibit the formation of prostaglandins that promote pain and inflammation. Since opioid-based medications are not anti-inflammatory agents, medications such as morphine, hydromorphone, and oxycodone are not considered the drugs of choice in treating most postoperative dental pain. Rather, these medications should be reserved for the small percentage of dental patients with severe, uncontrolled orofacial and postoperative pain, and even then, they are best prescribed as combination products that contain an NSAID as well as the narcotic moiety (Koppen et al, 2018; American Dental Association, 2020). Additionally, the American Dental Association (ADA) supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with Centers for Disease Control and Prevention (CDC) evidence-based guidelines (American Dental Association, 2020). Overprescription practices and inappropriate prescribing in certain medical and dental pain situations have led to a growing
problem of prescription drug abuse. In fact, much has been written in both professional and lay periodicals of late about the current opioid crisis, and the inappropriate prescribing of narcotic-containing pain medications has resulted in overdose deaths now exceeding deaths resulting from car accidents in the United States (Girion, Glover, & Smith, 2011; Moore et al., 2018). Most states have created prescription drug monitoring programs (PDMPs), and the U.S. Food and Drug Administration (FDA) and the Drug Enforcement Agency (DEA) continue to closely monitor prescribing practices, while tightening regulations around the prescribing of pain medications. The reclassification of hydrocodone-containing prescriptions from Schedule III to Schedule II, as well as the assignment of tramadol-containing medications to Schedule IV, are just two examples of the increasing scrutiny and regulatory restrictions. The ADA further supports improving the quality, integrity, and interoperability of state prescription drug monitoring programs (American Dental Association, 2020). Designed for dentists, dental hygienists, and dental assistants, this intermediate-level course will review the pharmacology of analgesic agents and update the learner on current guidelines and therapeutic choices in order to optimize analgesic prescribing practices. Since the goal of analgesic therapy is to ensure selection of the right drug at the right time and at the right dose for the right patient and the right procedure, the information presented in this course should be considered essential knowledge for all OHCPs, both seasoned and newly credentialed. Upon completing this course, the learner will be able to discuss the differences among analgesics typically prescribed for orofacial pain. In the case of unique patient populations requiring adjuvant options, the selection and timing of appropriate medications will no longer constitute a gap in knowledge. The principles learned will also be directly applicable to the appropriate selection of analgesics for the pregnant or breastfeeding patient and will aid in recognizing those patients with a significant allergic history and determining how to best and safely treat them.
OVERVIEW OF PAIN: TYPES OF OROFACIAL PAIN
Orofacial pain typically results from two general pathologic mechanisms: tissue injury and inflammation ( nociceptive pain ) or a primary lesion or dysfunction of the nervous system ( neuropathic pain ). The first step in management of orofacial pain is to determine if the pain is primarily nociceptive or neuropathic or a combination of the two. This determination is critical for selecting medication(s) whose mechanisms of action will address the underlying pathophysiology (Figure 1). Although this determination is often straightforward in instances of acute pain such as toothache or mucosal pain with proximate physical findings (tenderness, signs of injury and inflammation), the
process can be more challenging when the pain is persistent without a clear local cause (e.g., myofascial pain, neuropathic pain). Acetaminophen and the nonsteroidal anti-inflammatory drugs (NSAIDs) continue to be the most appropriate choices for the treatment of mild to moderate acute orofacial pain (Becker, 2010; Donaldson & Goodchild, 2010; Aminoshariae et al., 2016; Hersch et al., 2020). The use of cyclooxygenase-2 (COX‑2) inhibitor NSAIDs may be considered for patients at risk of gastrointestinal sequelae or those taking anticoagulants such as
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Book Code: DHFL2624
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