Interview with Grant Hunsicker: A Discussion on Opioid Use in Dental Care

A dental patient consulting a dentist

The opioid epidemic has forced many aspects of healthcare to take a second look at the potential impact opioid use can have on patients whose pain could have been managed otherwise. Dental medicine and oral surgery both require addressing pre- and post-procedural pain, and while eliminating pain is ideal from the patient’s perspective, it can create unrealistic expectations that result in serious complications down the road. 

Dr. Grant Hunsicker, DDS is an experienced dentist with extensive training in implants and aesthetics. He’s also a contributing expert and content creator for Premiere, and in this interview he offers some insight into evolving practices in dentistry surrounding opioids and prescribing practices in the industry. 

Premiere: Tell us about yourself and a little about what you do.

Grant: I'm a dentist here in Ohio. I've done some extensive implant training at the Midwest Implant Institute in Columbus, and I own several dental practices in the state. I focused a lot on aesthetics in addition to regular practice, and I strive for comprehensive care. I enjoy the improvements in people's lives you can affect with implants, and I like to change people's smiles. 

Premiere: What kind of content have you been doing for Premiere?

Grant: My most recent work is a course on diagnosing oral pain, and how that relates to prescribing opioids. It’s very important for the dental and healthcare industry because the DEA recently issued a new requirement to complete eight hours of continuing education on that subject. 

Premiere: What issues surrounding opioid prescriptions affect the dental profession?

Grant: Prior to the whole opioid pandemic during my residency, pain was considered the fifth vital sign in our industry. The solution typically meant writing a prescription for painkillers. Unfortunately, painkillers don’t necessarily treat the underlying issue, and as we’ve learned, pharmaceuticals like opioids can come with some serious implications. 

The mindset for dentists at the time—and particularly after performing oral surgery—was to follow up patient complaints of pain following, say, a wisdom tooth extraction, with an automatic prescription for 30 pills. This usually happened without any conversation about the nature of the pain or safe practices for avoiding addiction. 

Premiere: Have things changed?

Grant: Fortunately, that's not the way that dentists are practicing anymore. We’ve fundamentally reconsidered the nature of pain and taken a more critical approach to how and why painkillers are administered. 

The cause of pain isn’t “pain”, it’s inflammation-driven. Therefore, if you’ve just had major surgery, you can’t expect to be completely pain-free. Care and prescribing practices need to be about managing pain, not medicating until the patient can’t feel anything anymore. 

Premiere: How do you handle that aspect with a patient who’s experiencing pain?

Grant: It starts by having a realistic conversation about what to expect. For instance, if you have a major joint replacement, the simple fact is you’ve just had major and invasive surgery and you’re going to experience a degree of discomfort as a result. Doctors prepare patients for that and counsel them on how to manage it with lifestyle, health, and advice in addition to medication protocols. 

The same is true in dentistry. When patients have oral surgery, we now prepare them by saying, “Obviously you’re going to experience some pain, and we're going to give you a steroid to help with the inflammation. Here are some things to avoid, and some options if you’re uncomfortable. If you’re anything beyond sore, we want to talk to you.”

Opioids are an important part of the healthcare industry, but the path to them needs to be very carefully considered from a variety of patient-specific aspects.

Premiere: Are these best practices commonplace in dentistry today, or are there obstacles to messaging and change?

Grant: Things have improved a lot, but it takes a very long time to change the way people practice. The medical industry has had much greater success implementing new standards in the use of opioids. There used to be a lot of independently-practicing doctors and nurses, but today, most are incorporated in a hospital system. It’s much easier to update practices and enforce new standards of care when it’s a top-down mandate. 

However, dentistry has always been oriented towards private practice, and that makes disseminating information and changing behaviors much more challenging. New guidelines are typically communicated through dental association meetings, but they happen infrequently and may be poorly attended. 

Medical and dental practitioners also operate in very different environments with unique pressures. 

Antibiotic prophylaxis, as an example, for dental cleanings has been an ongoing issue between the dental community and orthopedic surgeons. The dental guidelines have not changed for over six years now, but as an independently practicing dentist it can be difficult to change prescribing practices, especially if it goes against what another medical professional might think. The common ground lies in continuing education, which is a critical and ongoing part of improving all standards of care. I would love to see a future where dentistry is brought more into the fold with the medical community and where good CE becomes as accessible to us as social media, music, and streaming services are now.

Premiere: Is continuing education required for your license?

Grant: It is. Current standards recently increased from something like 30 to 40 hours over two years, which in my opinion is nothing. However, even that marginal increase received a lot of pushback from dentists. I think part of the problem is that CE is viewed as a hassle, and many professionals don’t realize how easy it can be today.  

There's so much great CE from companies like Premiere that you can access virtually, so staying current should never be an impediment to any practicing medical professional. It’s so much easier today than it’s ever been, and spreading that message is a critical part of the solution to the opioid prescription challenge in dentistry today. 

Premiere: Final question: how did you get connected with Premiere?

Grant: Funny story—I met Megan Arbour because she was one of my patients! It turns out her father was a dentist in Maine, and because she’s in the healthcare industry we had a lot to talk about. One day she mentioned that my business and approach reminded me of her father’s informative and relatable approach to practice, and asked if I’d ever had any interest in the education side of dentistry. Our collaboration took off from there!

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