Canadian dentists take a bite out of unnecessary care

The Canadian Association of Hospital Dentists (CAHD) has joined our clinician colleagues from coast to coast in the Choosing Wisely Canada campaign. The list of recommendations ‘8 Things Dentists and Patients Should Question’, released April 18, is the first list by a dental association and society in the campaign. Choosing Wisely Canada currently has over 300 recommendations from nearly 50 medical specialty societies, along with national associations and societies representing pharmacists, nurses and other allied health care professionals.

Choosing Wisely Canada was first launched in 2014 in partnership with the Canadian Medical Association. The goal of the campaign is to start a conversation between clinicians and patients about unnecessary tests and treatments. There is a growing body of evidence showing that at least one third of medical tests, treatments and procedures are unnecessary. There is no similar overarching figure for dental care, though there is a large body of evidence highlighting specific examples of unnecessary tests, treatments and procedures in dentistry. Unnecessary tests, treatments and procedures are not just wasteful of health care resources but can lead to harm. Some harms are very obvious, such as adverse drug reactions, but others are subtler, such as patient anxiety and time spent away from work and other obligations. 

The CAHD list of recommendations provides a basis for starting to think about how dentists can collectively tackle unnecessary tests, treatments and procedures in our own practices, and as a profession. The list was led by a working group of dentists with both hospital-based and private practice experience, as well as diversity in gender, region and years in practice. An initial list of 25 recommendations was developed, reduced by consensus of the working group and was sent to all CAHD members, along with 14 national dental organizations and specialty groups for feedback. The final list was reviewed by the working group and endorsed by the CAHD Board.

The development of this list is a first step in dentists joining the national conversation on Choosing Wisely.

Eight Things Dentists and Patients Should Question

1. Don’t use opioids for post-operative dental pain until optimized dose of Nonsteroidal Anti-inflammatory Drugs (NSAIDs)/Acetaminophen has been used.
2. Don’t prescribe antibiotics for irreversible pulpitis (toothache).
3. Don’t routinely prescribe antibiotics for acute dental abscess without signs of systemic involvement.
4. Don’t give prophylactic antibiotics prior to dental procedures to patients with total joint replacement.
5. Don’t give prophylactic antibiotics to patients with non-valvular cardiac or other indwelling devices.
6. Don’t prescribe radiographs without indication.
7. Don’t replace fillings just because they are old.
8. Don’t remove mercury-containing dental fillings unless the restoration has failed.