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      Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond

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          Abstract

          Abstract: Over the past year our attention has inevitably been on the coronavirus pandemic, the health and welfare of our families, patients, and office staffs as well as the re-opening of our dental practices. In addition, the opioid crisis continues, is very likely to worsen as a result of the pandemic and continues to be a challenge to Dentistry. National public health issues and healthcare disparities continue and have created a global concern for providing evidence-based, adequate pain management in the dental setting. We have brought together a group of national thought leaders and experts in this field who will share their insights on the current state of opioid prescribing in Dentistry and describe some of the exciting work being done in advancing pain management.

          The learning objectives for this conference proceedings were:

          1. Describing the implications of current public health concerns for safe and effective pain management in dental medicine.

          2. Identifying risk factors and understanding the current guidelines for the use of opioid and non-opioid medications in dental medicine.

          3. Analyzing the interprofessional collaborations necessary for effective pain management in dental medicine.

          4. Recognizing the challenges and opportunities brought about by the COVID-19 pandemic for the dental profession.

          5. Applying evidence-based strategies for managing the complex pain patient in the dental setting.

          6. Appraising new and future modalities for the assessment and management of orofacial pain.

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          Most cited references 88

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          The path to personalized medicine.

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            Finding the missing heritability of complex diseases.

            Genome-wide association studies have identified hundreds of genetic variants associated with complex human diseases and traits, and have provided valuable insights into their genetic architecture. Most variants identified so far confer relatively small increments in risk, and explain only a small proportion of familial clustering, leading many to question how the remaining, 'missing' heritability can be explained. Here we examine potential sources of missing heritability and propose research strategies, including and extending beyond current genome-wide association approaches, to illuminate the genetics of complex diseases and enhance its potential to enable effective disease prevention or treatment.
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              Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation.

              The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses. JAMA. 2000;284:1689-1695.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                jpr
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                24 May 2021
                2021
                : 14
                : 1371-1387
                Affiliations
                [1 ]Department of Diagnostic Sciences, Craniofacial Pain and Headache Center, Tufts University School of Dental Medicine , Boston, MA, USA
                [2 ]Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Department of Surgery, Massachusetts General Hospital , Boston, MA, USA
                [3 ]Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital , Boston, MA, USA
                [4 ]Department of Biological and Material Sciences & Prosthodontics, University of Michigan School of Dentistry, Headache and Orofacial Pain Effort, University of Michigan , Ann Harbor, MI, USA
                [5 ]fNIRS Laboratory, University of Michigan , Ann Harbor, MI, USA
                [6 ]Department of Public Health and Community Service, Tufts University School of Dental Medicine , Boston, MA, USA
                [7 ]Department of Diagnostic Sciences, Tufts University School of Dental Medicine , Boston, MA, USA
                [8 ]Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston, SC, USA
                [9 ]Department of Pharmaceutical Services, School of Pharmacy University of California , San Francisco, CA, USA
                [10 ]Department of Clinical Pharmacy, San Francisco Medical Center , San Francisco, CA, USA
                [11 ]Department of Plastic and Oral Surgery, Boston Children’s Hospital , Boston, MA, USA
                [12 ]Harvard School of Dental Medicine , Boston, MA, USA
                [13 ]Harvard Medical School , Boston, MA, USA
                [14 ]Columbia University College of Dental Medicine , New York, NY, USA
                [15 ]Columbia University Medical Center , New York, NY, USA
                [16 ]Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital , Boston, MA, USA
                [17 ]Department of Public Health & Community Medicine, Tufts University School of Medicine , Boston, MA, USA
                [18 ]School of Social Work, North Carolina State University , Raleigh, NC, USA
                Author notes
                Correspondence: Michael E Schatman Tel +1 425647-4880 Email Michael.Schatman@Tufts.edu
                Article
                319373
                10.2147/JPR.S319373
                8164473
                © 2021 Scrivani et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 0, References: 100, Pages: 17
                Categories
                Meeting Report

                Anesthesiology & Pain management

                covid-19, dentistry, pain management, opioid analgesia

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