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Study Objective: High prescribers of antibiotics and opioids are an important target for stewardship interventions. The goal of this study was to assess the association between high antibiotic and high opioid prescribing by provider type. Design: A national cross‐sectional study. Setting: 2015–2017 Department of Veterans Affairs (VA) electronic health record data. Population: Prescribers were identified as dentists (2017: n = 1346) and medical providers (physicians n = 23,072; advanced practice providers [APP] n = 7705; and other providers [pharmacists/chiropractors] n = 3674) (2017: n = 34,451). Measurements: High prescribing was defined as being in the top 25% of visit‐based rates of antibiotic or opioid prescribing (number of prescriptions/number of dental or medical visits). Multivariable random effects logistic regression with clustering by facility was used to assess the adjusted association between high antibiotic and opioid prescribing. Results: Medical providers prescribed 4,348,670 antibiotic and 10,256,706 opioid prescriptions; dentists prescribed 277,170 antibiotic and 124,103 opioid prescriptions. Among all high prescribers of antibiotics, 40% were also high prescribers of opioids as compared to 18% of those who were not high antibiotic prescribers (p < 0.0001). High prescribing of antibiotics was associated with high prescribing of opioids in medical providers (adjusted odds ratio [aOR] = 2.87, 95% confidence interval [CI] = 2.72–3.04) and dentists (aOR = 8.40, 95% CI 6.00–11.76). Older provider age, specific US geographic regions, and lower VA facility complexity and rurality were also associated with high opioid prescribing by medical providers. In dentists, younger provider age, male gender, specific regions of the United States, and lower number of dentists in a facility were associated with high opioid prescribing. At the facility level, high dental prescribers of antibiotics or opioids were not at the same facilities as high medical prescribers, respectively (p < 0.0001). Conclusions: High antibiotic prescribing was associated with high opioid prescribing. Thus, stewardship interventions targeting both medication classes may have higher impact to efficiently reduce prescribing of medications with high public health impact. Provider‐targeted interventions are needed to improve antibiotic and opioid prescribing in both dentists and medical providers. [ABSTRACT FROM AUTHOR]

Opioid misuse is a widespread public health problem, and opioids are often prescribed in the dental environment. These recommendations provide alternatives to opioids to reduce or eliminate dental procedure–related acute pain. A multidisciplinary working group developed these clinical recommendations to specifically address procedure-related acute pain. These recommendations, which are based on published peer-reviewed research and guidelines, include therapies used before, during, and after dental procedures. When evidence is not definitive, the best practices, which are based on experts' consensus, are included. The recommendations are not intended to be exhaustive. These recommendations are a summary of the evidence and best practices for opioid alternatives to treat acute pain related to dental procedures. Dental providers should prioritize opioid stewardship when managing procedure-related pain with strategies such as thorough preprocedure pain assessment, minimally invasive techniques, preemptive analgesia, intraprocedure pain management, and appropriately selected postprocedure pharmacologic therapy. These recommendations are a concise resource for clinical providers. It is important to address patients' procedure-related pain, using nonopioids whenever possible. Alternatives are outlined, allowing providers to make informed decisions. [ABSTRACT FROM AUTHOR]

Background: The Global Burden of Disease Study showed there was a 34.5% increase in years lived with disability due to dental caries from 1990 to 2010. With the aging of 76 million baby boomers, dental caries will continue to pose a significant challenge for older adults. Objective: Test the effectiveness of prescription or professionally applied fluoride in the prevention of new dental restorations in a clinical setting where patients are medically compromised and more dentally impaired than the general population. Methods: A retrospective cohort study, using multiple electronic databases within the Department of Veterans Affairs. Propensity scores were used to adjust for confounding by indication and logistic regression modeled the outcome and included all expected covariates. Results: The study sample included 140 114 high caries risk Veterans with a mean of 3.4 physical comorbidities, 1.2 mental comorbidities, and 11 medication groups per patient. Patients who received clinical fluoride treatments had 17-20% decreased odds of requiring a restoration during the follow-up period. Conclusions: Prescription self-applied or professionally applied fluoride provided either before or during an episode of care significantly reduced the likelihood of new restorations in high caries risk and medically compromised Veterans. [ABSTRACT FROM AUTHOR]

Background. Staff of the VA Office of Dentistry, the dental care arm of the U.S. Department of Veterans Affairs' Veterans Health Administration, developed a performance measure (PM) regarding appropriate fluoride use. The authors hypothesized that after the implementation of this PM, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past. Methods. In a retrospective longitudinal analysis, the authors evaluated the effectiveness of a PM in reducing restoration rates in veterans at high risk of experiencing caries. They evaluated changes in restoration rates for all eligible veterans, as well as the subpopulation at high risk of experiencing caries (defined as receiving two or more restorations in 12 months) both before and after the implementation of the PM. Results. In 2012, 81 percent of clinics provided fluoride for more than 90 percent of their patients at high risk of experiencing caries. After use of the PM for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period. Conclusions. Fluoride use for patients at high risk of experiencing caries rose from 51.8 percent in 2008 to 93.6 percent in 2012. Restoration rates rose before implementation of the PM and fell consistently after its implementation. Practical Implications. Fluoride use reduces the need for future restorations in adults at high risk of experiencing caries. [ABSTRACT FROM AUTHOR]

Objectives. In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Methods. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Results. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Conclusions. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation. [ABSTRACT FROM AUTHOR]

Dental care has been a component of services the nation has made available to its veterans for nearly a century. The demographics of VA's patients have led VA dentistry towards a heightened focus on and contributions towards improved oral health care of older and medically compromised adults. VA Dental Services treat adults 65 and older at twice the estimated rate of private dental practitioners. This patient population has also made VA dentistry an ideal setting for educating dental practitioners to treat aged and medically compromised patients, and a prolific contributor to the body of research in this area. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Qualitative interviews with dentists offered possible intervention targets to expand implementation of safe opioid prescribing for acute dental pain management within the Veterans Affairs. The U.S. Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States and provides dental care to approximately one-half million veterans annually. In response to the opioid crisis, the VA released several opioid risk mitigation strategies. Although opioid prescribing by VA dentists has decreased on the whole, the implementation experiences at the level of dentists remains unclear. Our objective was to explore the barriers and facilitators that affect opioid decision making for management of acute dental pain among VA dentists. Dentists practicing in the VA facilities with the highest and lowest volume of opioid prescriptions were recruited. Standardized qualitative interviews by telephone followed a semistructured guide designed around the Capability (C), Opportunity (O), Motivation (M), and Behaviour (B) model. Audio recordings were transcribed and independently double-coded using NVivo to identify potential targets for future guideline-based opioid interventions. Of 395 eligible general and specialty dentists, 90 (24.8%) completed an interview representing 33 VA facilities. Opportunities for prescribing opioids included 1) completion of dental procedures associated with acute dental pain, 2) caring for patients who presented with existing dental pain, and 3) responding to patient opioid requests. Capabilities included using resources (eg, electronic medical records), clinical judgement (eg, evaluation of medical history including medication use), communication skills, and ability to screen for opioid misuse. Motivation themes focused on alleviating patients' acute dental pain. Barriers and facilitators of opioid prescribing varied across facilities. The results can offer intervention targets for continued opioid risk mitigation efforts. [ABSTRACT FROM AUTHOR]