Type to search

Pharmacology Supporting Your Practice

Could the prescription you write put you in legal jeopardy?

It was with much pleasure that I hosted once again Dr. Mark  Donaldson on CDA Oasis. Dr. Donaldson has been kind and most generous in sharing his recent publications as well as his expertise on very important pharmacological topics. Today he speaks to our audience about the liabilities dentists might incur when prescribing opioids in light opioid crisis experienced in North America.

 Dr. Donaldson is senior executive director at Vizient Pharmacy Advisory Solutions as well as clinical professor in the Skaggs School of Pharmacy at the University of Montana.

I hope you enjoy and benefit from the conversation. Always remember that your questions, thoughts and suggestions are welcome on CDA Oasis and you may share them with us at oasisdisscussions@cda-adc.ca

Until next time!

Chiraz Guessaier
CDA Oasis Manager


  • Unlike the original war on drugs, the campaign to address this new epidemic is complicated by the fact that access to these prescription opioids is often attained via legal means. In many cases, it is the misprescribing or overprescribing of narcotic-containing medications that creates the conduit for public access to these drugs.
  • Since dentists follow primary care physicians as the second-leading prescribers of immediate release opioids, oral healthcare professionals have been identified as having an important role in opioid abuse prevention efforts.
  • If changing current prescribing habits based on new data and guidelines is not enough for individual clinicians, then recent legal cases may be the impetus for change.
  • Before determining the “safe” amount of opioids to prescribe patients for postoperative orofacial pain, clinicians must realize that opioid analgesic prescriptions should not be an initial treatment strategy except in extreme cases.
  • In fact, nonsteroidal anti-inflammatory analgesics (NSAIDs) such as ibuprofen are at least as effective as acetaminophen-opioid pain relievers and have lower incidences of adverse effects. Because of the safety and efficacy of NSAIDs, they should continue to be first-line medications for managing postoperative pain unless contraindicated.
  • Consistent with best-practice recommendations, opioids should be reserved for only a minority of cases involving moderate to severe postoperative pain in which all other management options have been exhausted.

Full Interview (13.49″)


1 Comment

  1. Graham McMillan March 14, 2018

    Let’s first take caution in accepting the advice from someone who has never surgically extracted teeth, dealt with oral and maxillofacial trauma, or tried in vain to manage runaway endodontic pain. No patient would ever return after spending a weekend in pain while the white knight dentist fumbles with pain medication.

    My training from 25 years ago addressed pain medication prescriptions in great detail including the judicious use of opioids AND steroids. The opioid epidemic stems from physicians, particularly in the US, writing out huge scripts for opioids (200 Percocet at a time). We in dentistry rarely if ever prescribe more than 18 Tylenol 3’s at a time for osseous surgery and furthermore, in today’s world, a script for 40 Tylenol 3’s will likely get you a phone call from an enquiring pharmacist.

    It is vital if one suspects severe inflammatory pain post operatively to include the injection of Dexamethasone at the time of surgery and perhaps prescribe more for 1-2 days. The experienced clinician finds that messing with weak drugs like Ibuprofen and Acetaminophen in the face of severe pain is a fruitless venture. This is not new thinking. Yes the message of Dr. Donaldson is a good one, but as experts in pain, we as dentists from Canadian schools were taught very well on this subject.


Leave a Comment

Your email address will not be published. Required fields are marked *