Patient-Provider Dialog: A Key to Improving Satisfaction after Third Molar Extraction

Oral Abstract Track Three serve as a pre-surgical diagnostic similar to NST by correlating NST, MRN and surgical findings. Methods: Fifty-three patients from 4/2015 to 12/2016 with PTTN injuries of varying etiologies and Sunderland classifications underwent NST followed by MRN at 1.5T and 3T scanners. The protocol included 2D and 3D imaging, namely, coronal isotropic 3D PSIF (0.9mm). The MRN findings were read by two readers in consensus in the light of clinical findings, but blinded to the side of abnormality. The MRN results were summarized using Sunderland Classification. The NST results were reported using the same classification. In 19 patients, surgery was performed and Sunderland Classification was assigned based on surgical photos and/or histology. Agreement between MRN and NST/Surgical classification was evaluated using Kappa statistics. Pearson’s Correlation Coefficient (PCC) was used to assess the correlation between continuous measurements of MRN/NST and surgical classification. Results: Fifteen males and 38 females, mean age 4115 years, range 12 to 75 years, with 49 complaints of altered sensation of the lip/chin/or tongue, including 14 with neuropathic pain, and 4 with no neurosensory complaint were included. Third molar surgery (n=23) represented the most common cause of PTTN. The Sunderland Classification based on NST ranged from I (2); II (11); III (9); IV (9), V (3), II/III (2); IV/V (4); normal (2); indeterminate (11). Surgical findings included II (4); III (5); IV (5); V (5). MRN was indeterminate in 2 cases. Assuming 1 nerve abnormality per patient and when classification was indeterminate, the lower class was accepted, and the Kappa of 0.57 was observed between MRN and NST classifications. A Kappa of 0.4 existed between MRN and Surgical findings with a PCC of 0.57. Conclusions: MR Neurography can anatomically map PTTN injury and stratify the nerve injury with moderate agreements with NST and surgical findings for clinical use. The application of a non-invasive objective modality like MRN to determine the classification and characteristics of an injured trigeminal nerve earlier than NST can be tested in prospective studies in future as it could serve as an important technique for outlining treatment decisions and determining patient outcomes. 1. Chhabra A, Thawait GK, Soldatos T et al: High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. Am J Neuroradiol 34:486, 2013 2. Zuniga JR, Meyer RA, Gregg JM et al: The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg 56:2, 1998

The Use of Smart Forms for the Electronic Collection of Prospective TMJ Data

tive studies while high quality prospective data remains the goal. The objective of this presentation is to demonstrate how a prospective TMJ study was developed and maintained using electronic reporting (automated data collection) via Smart Forms. A prospective exempt study was designed and IRB approved including all patients presenting to the University of Michigan for the surgical management of TMJ disorders since March 2016. Select patient questionnaire results, history of present illness, physical exam, and radiographic findings were chosen for data collection. A SmartFrom layout was created for initial TMJ consults and return visits using the Epic build tools workspace. Each data line was assigned an individual smart data element number allowing data extraction into customizable reports. Data entered in SmartForms using MiChart were stored in the Clarity database and a report is generated using Oracle SQL by using the individual form IDs and Smart data element IDs. The data output reports are delivered via Excel files that are then formatted to the PIs specifications for optimal data analysis. Statistical analysis is not applicable. Using provider-specific Smart Forms and electronic reporting, complete data sets were collected prospectively on 229 new patient TMD consults, 69 TMJ arthroscopy follow-ups, and 18 TMJ arthroplasty follow-ups. Time consuming or costly chart reviews required for traditional data collection in clinical studies was avoided and will not be required. Compared to traditional retrospective studies where chart review reveals many missing data elements and smaller than ideal sample sizes, no data elements were missing using Smart Forms. Using Smart Forms and Clarity reporting, prospective and automatic collection of TMJ baseline and outcome data was achieved and will continue to achieve a large sample of high quality data. Use of this technology facilitates single or multi-centered uniform data collection to address numerous research questions with the goal of strengthening the body of evidenced-based diagnostic and therapeutic modalities in the TMJ domain and beyond. References: 1. Schnipper JL, Linder JA, PAlchuk MB et al. ‘ Smart Forms’’ in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management. J Am Med Inform Assoc. 2008. 15(4):513-523 2. Hohnloser JH, Puerner F, Soltanian H. Improving coded data entry by an electronic patient record system. Methods Inf Med. 1996. 35(2):108-111

Patient-Provider Dialog: A Key to Improving Satisfaction after Third Molar Extraction

S. Aronovich: University of Michigan

S. U. Stucki-McCormick: Private practice, P. Franco, B. L. Ferguson, D. W. Fain

The large proportion of available data for the surgical management of TMJ disorders is derived from retrospec-

Introduction: Dental pain and fear of oral surgery can affect patients’ perceptions of their providers.1 Offering

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Oral Abstract Track Three patients or parents of patients requiring surgery more information about a presenting dental problem, and treatment options, may alleviate anxiety and improve overall satisfaction.2 This survey was conducted to better understand patient preferences and attitudes about how their oral surgeon manages their pain. Materials and Methods: We conducted an anonymous, electronic, cross-sectional US survey, using Nielsen’s Harris Poll Online, between June 23 and July 8, 2016. The survey was independent of any provider or practice. In order to respect informed consent, 2 groups were surveyed: (1) adults (aged $18 years) who underwent third molar extraction in the past 12 months and parents of patients aged 18–24 years who had the surgery in the past 12 months or expected to have it in the next 12 months. The target sample size was 1500. The survey included >250 questions and took approximately 15 minutes to complete. It collected demographic information and asked about responders’ attitudes, expectations, and experiences with respect to third molar extraction and postsurgical pain management. Responses were analyzed descriptively using means and percentages. Results: After screening 26,580 responses, we identified 1502 qualified responders. Here, we report data from 1000 patients (half men, half women) and 251 parents of patients. Of those prescribed or recommended a pain medication (patients, 95%; parents of patients, 97%), the majority (70% and 69%, respectively) were prescribed an opioid, with 93%–95% filling the prescription. Most patients and parents of patients (80%–89%) reported discussing pain medication with the surgeon during the presurgical consult. However, 31%–42% indicated that the conversation was initiated not by their surgeon but by a staff member. Most wished that during the consult they had asked about expected severity (68%– 73%) and duration (69%–77%) of postsurgical pain. Also, most (56%–62%) would have liked more information about potential adverse effects of the medication, as many of those who had discussed pain medication during the consult were not given such information (59%–61%). Most responders (75%) knew that an opioid had been prescribed. However, when asked how they knew, only 45%–56% noted having been informed before the procedure and only 27%–29% at the time the opioid was prescribed. Importantly, although all those prescribed an opioid received dosage instructions, one-quarter were not told when to stop the medication. The majority of patients and parents of patients (89%– 92%) thought that both the patient and provider should be involved in pain management decisions, but among those who talked about pain medication with their provider, only 25%–28% discussed having a choice of pain medication. Most responders indicated that they would prefer a provider who offers nonopioid options (Table). Conclusions: This survey shows that there is opportunity for clinicians to have improved dialog with patients e-358

Table Opinions on nonopioid pain management options Responders

Agree Agree Agree Somewhat/ Somewhat Strongly Agree Strongly

Patients 39% 30% 69% 43% 28% 71% Parents of patients who had procedure Responders indicated how much they agreed or disagreed with the following statement: I would prefer to (or I would prefer my young adult to) go to a provider who offers effective nonopioid pain management options.

and parents of patients regarding what medication they are prescribed and when to stop taking it. Patients and parents want to be active participants with surgeons, not staff, and would prefer a provider who offers nonopioid alternatives. Funded by: Pacira Pharmaceuticals, Inc. References: 1. Kunzelmann KH and Dunninger P. Community Dent Oral Epidemiol. 1990;18(5):264-266 2. Appukuttan DP. Clin Cosmet Investig Dent. 2016;8:35-50

Large US Survey of Opioid Use for Pain Management Following Third Molar Extraction: Unused Medication and Implications for Clinical Practice S. U. Stucki-McCormick: Private practice, B. L. Ferguson, P. Franco, D. W. Fain Objective: Oral surgery is a common source of opioid prescriptions, which have potential for misuse and abuse, with up to an estimated 23% of prescribed doses being used nonmedically.1,2 In most cases, such medication is obtained from friends or family members originally prescribed the medication; adolescents are at particular risk for resulting initial opioid exposure.1,2 We conducted a survey to examine opioid use for pain management after third molar extraction, focusing on prescribing practices and unused medication. Materials and Methods: An anonymous, electronic, cross-sectional US survey, independent of any provider or practice, was conducted using Nielsen’s Harris Poll Online. The survey took place between June 23 and July 8, 2016. Two groups were surveyed: adults (aged $18 years) who underwent third molar extraction in the past 12 months and parents of patients aged 18–24 years who had the surgery in the past 12 months or expected to have it in the next 12 months. Responses to the >250 questions were analyzed descriptively using means and percentages. Results: A total of 26,580 responses were screened; results are reported for 1000 patients and 251 parents of patients who had the surgery. Among the 95%–97% of AAOMS  2017