Baker-Polito Administration, MA Dental Schools, and the MA Dental Society Announce Dental Core Competencies to Combat Opioid Epidemic


Dental School Core Competencies Aimed to Properly Train Students on Prevention and Management of Prescription Drug Misuse
BOSTON-Last week the Baker-Polito Administration, in partnership with the deans of the Commonwealth’s three dental schools and the Massachusetts Dental Society, announced a first-in-the-nation set of dental education core competencies for the prevention and management of prescription drug misuse.
This set of cross-institutional core competencies will ensure that the Commonwealth’s more than 1,800 enrolled undergraduate dental students and 550 advanced graduate dental students receive enhanced training in primary, secondary, and tertiary prevention strategies regarding prescription drug misuse.
“Educating our dental providers on prescribing practices for opioids is a critical step toward preventing drug misuse as we continue to combat this public health crisis,” said Governor Baker. “We are thrilled to stand with the Commonwealth’s dental schools and the Massachusetts Dental Society to introduce our second set of core competencies that are bound to educate our students and help curb this epidemic.” 
The Governor’s Working Group on Dental Education on Prescription Drug Misuse was led by State Public Health Commissioner Monica Bharel, MD, MPH and included key representatives from all three Massachusetts schools of dental medicine – Boston University Henry M. Goldman School of Dental Medicine, Harvard School of Dental Medicine, and Tufts University School of Dental Medicine – in addition to the Massachusetts Dental Society and the Massachusetts Department of Public Health.
Each school will tailor the core competencies to complement their existing curricula in order to ensure they are being delivered to all students.
“We applaud the deans’ commitment to increasing their students’ understanding of the use and potential misuse of opioids and for joining the Administration in tackling the Commonwealth’s opioid epidemic,” said Health and Human Services Secretary Marylou Sudders.
Last November, the Baker-Polito Administration announced its first partnership with deans from the Commonwealth’s four medical schools and the Massachusetts Medical Society for a set of groundbreaking medical education core competencies for the prevention and management of prescription drug misuse. The set of cross-institutional core competencies will ensure that the more than 3,000 enrolled medical students across the Commonwealth receive enhanced training in primary, secondary, and tertiary prevention strategies regarding prescription drug misuse.
“Substance misuse is a chronic disease, and we must treat it as one, starting with education of our clinicians,” said Public Health Commissioner Monica Bharel, MD, MPH. “We must approach the treatment of this disease taking into account the multiple needs of the individual, not just substance misuse.”
Boston University Henry M. Goldman School of Dental Medicine: “The core competencies will re-enforce the foundational aspects of pain management and recognition of the signs of substance misuse that are presently taught in the pre-doctoral and residency curriculum, and will help to overcome the stigma associated with substance misuse and provide an understanding in the evaluation and proper referral of these patients to the appropriate treatment facilities. The project will also provide for intra- and inter-professional educational experiences that will be beneficial for all involved. Boston University Henry M. Goldman School of Dental Medicine looks forward to the implementation of this most important undertaking.” – Dean Jeffrey W. Hutter, DMD, MA
Harvard School of Dental Medicine: “Dental medicine has an expanding role in promoting public health, with an increased attention to inter-professional collaboration across a range of healthcare disciplines. The need for this collaborative effort is most evident when the patient presents with complex medical and psychiatric comorbidities. For example, the patient can benefit from integrative care, after dental surgical procedures where controlled substances are dispensed as a standard of care. Dentists are in a particularly unique position to have an impact, as they typically have regular contact with their patients and commonly address issues of preventive health and wellness in their oral health regimes. ” – Dean Bruce Donoff, DMD, MD
Tufts University School of Dental Medicine: “As a dentist may be the first person a patient sees where strong medications are needed for pain, it is of utmost importance that the clinician understands the significance of assessing that patient for substance misuse risk, while still needing to effectively treat their pain. It is only through sound dental educational programs and standards that a thorough appreciation of an effective treatment regimen can be established.” – Dean Huw Thomas, BDS, MS, PhD, Co-Chair of the Governor’s Dental Education Working Group
Massachusetts Dental Society: “A patient complaining of acute tooth pain is a common problem that dentists treat. This short-term pain is relative to each patient and therefore the dentist must make a professional decision to help resolve the pain after surgical procedure. Effective pain management is an important part of dentistry. The Massachusetts Dental Society supports efforts to balance proper pain management with patient safety. Therefore, we applaud the Governor in his initiative to develop core competencies to address the opioid crisis. This effort caused an inter-professional collaboration to develop core competencies on opioid prescribing to deal with potential prescription drug misuse. The standards developed for dentistry will strengthen the dental school curriculum; provide current dental professionals with additional guidance on evaluating substance misuse and patient referral to community treatment programs. The Massachusetts Dental Society supports these core competencies.” – Raymond K. Martin, D.D.S., M.A.G.D., President-Elect for the Massachusetts Dental Society
Core Competencies for the Prevention and Management of Prescription Drug Misuse
In the appropriate setting, using recommended and evidence-based methodologies, the graduating dental student should demonstrate the independent ability and/or knowledge to:
Primary Prevention Domain – Preventing Prescription Drug Misuse:

Screening, Evaluation, and Prevention of Substance Misuse During the Diagnosis of Dental and Orofacial Pain

Evaluate a patient’s pain using age, gender, and culturally appropriate evidence-based methodologies, together with history, physical examination and relevant imaging studies to develop an appropriate differential diagnosis.

Evaluate a patient’s risk for substance use disorders by utilizing age, gender, and culturally appropriate, evidence-based communication skills and standardized assessment methodologies, supplemented with relevant available patient information, including but not limited to health records, family history, prescription dispensing records (e.g. the Prescription Drug Monitoring Program), screenings for commonly co-occurring psychiatric disorders (especially depression, anxiety disorders, and PTSD), review of relevant medical records, and communication with co-treating clinicians.

Identify and describe potential pharmacological and non-pharmacological treatment options including opioid and non-opioid treatments for acute and chronic pain management, along with patient and family communication and education regarding the risks and benefits associated with each of these available treatment options, securing of medications, and proper disposal.

Secondary Prevention Domain – Treating Patients at Risk for Substance Use Disorders:

Engage Patients in Safe, Informed, and Patient-Centered Treatment Planning

Demonstrate the ability to appropriately refer patients to their primary care physician, mental health specialists, pain specialists, and substance use treatment programs for consultation and collaboration.

Practice evidence-based and patient-centered pain management treatment plans for patients with acute and chronic pain.

Provide special attention to safe prescribing and recognizing patients displaying signs of aberrant prescription use behaviors.

Demonstrate the foundational skills in patient-centered counseling and behavior change in the context of a patient encounter, consistent with evidence-based techniques.

Tertiary Prevention Domain – Managing Substance Use Disorders as a Chronic Disease:

Eliminate Stigma and Advance Interdisciplinary and Inter-professional Collaborative Efforts to Reduce Substance Misuse

Recognize the role of currently available screening instruments for at-risk patients, and support the development of instruments and protocols that are tailored to dental practice.

Work toward eliminating the stigma associated with substance misuse, recognizing substance use disorders as a chronic disease that can be treated with effective assessment, referral, and inter-professional collaboration.

Develop models of inter-professional education where dentists, physicians, nurses, pharmacists, mental health clinicians and other critical disciplines can engage in collaborative training, to facilitate best practices and the optimal care of our patients.

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