Opioid Abuse and Dependence in Those Hospitalized Due to Head and Neck Cancer.

PURPOSE: In the United States, 2.1 million people develop substance abuse disorders that are associated with prescribed opioids. The objective of the present study was to identify the factors associated with opioid abuse and dependence (OAD) in those hospitalized for head and neck cancer (HNC). Although measures are being implementing to reduce opioid prescribing, the use of these drugs in individuals with HNC can be valuable. However, little is known about OAD among this cohort of individuals. MATERIALS AND METHODS: The present study was a retrospective analysis of the Nationwide Inpatient Sample for 2012 to 2014. All patients hospitalized because of any HNC were selected. The OAD prevalence was identified. The patient demographic, hospital, and geographic factors were considered independent variables and OAD was the outcome. Multivariable logistic regression model was used to identify the factors associated with OAD. RESULTS: A total of 92,055 patients were hospitalized because of HNCs. OAD was prevalent in 0.8% of the patients. The OAD rates were greatest in patients with a malignant neoplasm of ill-defined sites within the lip, oral cavity, and pharynx (1.6%). Age 30 to 44 years (odds ratio [OR] 5.19, 95% confidence interval [CI] 2.23 to 12.06; P < .01) and age 45 to 64 years (OR 4.05, 95% CI 2.15 to 7.61; P < .01) were associated with greater odds for OAD compared with age older than 64 years. Black (OR 1.76, 95% CI 1.12 to 2.78; P = .01) and Hispanic (OR 2.20, 95% CI 1.27 to 3.79; P < .01) race/ethnicity were associated with greater odds for OAD compared with white race/ethnicity. Individuals covered by Medicaid (OR 2.08, 95% CI 1.26 to 3.43; P < .01), and those who were uninsured (OR 2.27, 95% CI 1.05 to 4.89; P = .04) were associated with greater odds for OAD compared with those covered by private insurance. An increase in the comorbid burden was associated with increased odds of OAD (OR 1.57, 95% CI 1.47 to 1.68; P < .001). CONCLUSIONS: The present study identified specific anatomic sites where malignant neoplasm was associated with greater odds of OAD. Additionally, the study found that coverage by Medicaid, black and/or Hispanic race/ethnicity, lowest income households, and a greater comorbid burden were associated with greater odds of OAD.

Opioid abuse/dependence among those hospitalized due to periapical abscess.

AIM: Opioid abuse/dependence (OAD) is an emerging public health crisis in the USA. The aim of the present study was to estimate the nationwide prevalence of OAD in those hospitalized due to periapical abscess in the USA. METHODS: The Nationwide Inpatient Sample for 2012-2014 was used. All patients who were hospitalized due to periapical abscess were selected for analysis. In this cohort, OAD was identified and used as the outcome variable. A mix of patient and geographic factors were used as independent variables. The simultaneous association between outcome and independent variables was examined by a multivariable logistic regression model. Clustering of outcomes within hospitals was adjusted. Odds of OAD were computed for all independent variables. RESULTS: During the study period, 30 040 patients were hospitalized due to periapical abscess; 1.5% of these had OAD. Those aged 18-29 years (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.76-7.72, P < 0.01) and 30-44 years (OR = 3.19, 95% CI = 1.77-5.76, P < 0.01) were associated with higher odds for OAD compared to those aged 45-64 years. Blacks were associated with lower odds for OAD compared to whites (OR = 0.52, 95% CI = 0.28-0.95, P = 0.03). Those covered by Medicare (OR = 4.08, 95% CI = 1.458-11.44, P = 0.01), Medicaid (OR = 5.86, 95% CI = 2.22-15.47, P < 0.01), and those who were uninsured (OR = 3.68, 95% CI = 1.30-10.45, P = 0.01) were associated with higher odds for OAD compared to those covered by private insurance. The odds of OAD increased with comorbid burden (OR = 1.66, 95% CI = 1.50-1.84, P < 0.01). CONCLUSIONS: High-risk groups that are likely to have OAD were identified among those hospitalized due to periapical abscess.

Review: An overview and analysis of novel oral anticoagulants and their dental implications.

BACKGROUND: Dabigatran, rivaroxaban, apixaban and edoxaban are approved novel oral anticoagulants (NOACs) as alternatives to Vitamin K antagonists (VKA). Physicians are prescribing an ever-increasing amount these drugs to their patients due to various advantages over existing medications. AIMS: The objective of this review is to provide the dental professional with current literature surrounding the emergence of NOACs, as well as various case studies on the subject, in an effort to guide clinical decision making regarding these medications. The pharmacological profiles of these NOACs and idarucizumab, a reversal agent for dabigatran, will be detailed in this review. MATERIALS AND METHODS: A review of the literature on NOACs was undertaken and the Pubmed, Medline, and Embase databases were used to identify articles published in the English language. Additionally, major dental medicine journals were hand searched, followed by a review of the ClinicalTrials.gov database. RESULTS: Due to minimal research regarding dental treatment of patients on NOACs and minimal clinical experience of practitioners treating these patients, there is currently insufficient data to establish an evidence-based NOAC management protocol in a dental setting. DISCUSSION: In this review, the most significant advantages of NOACs over VKAs was found to be limited interactions with other drugs as well as rapid onset and offset of action. CONCLUSION: Despite these benefits, as well as various others, NOACs still lack specific management parameters as well as antidotes or reversal agents. Therefore, dental professionals must use caution when treating patients currently taking these specific anticoagulants.

A Reflection Curriculum for Longitudinal Community-Based Clinical Experiences: Impact on Student Perceptions of the Safety Net.

Community-based dental education (CBDE) allows dental students to be immersed in community settings and provide care to populations that are underserved. Exposure to those groups during training may impact provider attitudes, which may be strengthened by supporting students' reflection and exploration of their own attitudes. The aim of this study was to describe the implementation and preliminary results of a pilot longitudinal reflection curriculum integrated into a community-based clinical experience (CBCE) for senior dental students at one U.S. dental school and to report the impact of the reflection curriculum and CBCE on student experiences with populations that are underserved. In academic year 2015-16, all 35 senior dental students at one U.S. dental school were invited to complete an 11-item survey before and after completing a 12-week CBCE with integrated, longitudinal online reflections. Students received feedback from a faculty member after each reflection. All 35 students completed the survey, for a 100% response rate. After the CBCE, the students reported improved clinical efficiency and increased confidence in treatment planning and in treating dental emergencies and dentally anxious patients. They also reported improved understanding of the structure and relevance of community health centers, the role of different health care team members, and the impact of health policy. There was no significant difference in future plans to work with groups that are underserved. These results suggest that the CBCE and reflection curriculum had a positive impact on the students' clinical confidence as well as expanding their understanding of the broader oral health care delivery system. To address persistent oral health disparities, dental schools should continue to adopt CBDE programming that will prepare providers to effectively care for populations that are underserved.