Understanding Pain after Dental Procedures

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Project Summary/Abstract Pain is a common, and unwelcome aftermath of seeing the dentist. Indeed, pain has been deemed the fifth vital sign and many describe it as an adverse event (AE). After the effects of the most commonly-used local anesthetic diminishes, dental patients must rely on themselves and their own understanding for pain management following dental procedures. This has led to an over-reliance on prescribed opioids as there are no means to actively track patients' pain once they leave the clinic. To understand effective/appropriate pain management, we need to examine the pain levels experienced by patients caused by which dental procedures. Such an inventory will allow providers to anticipate and better manage their patients' post-operative pain. Innovative mobile applications and connected health technologies that allow real-time tracking of patients' symptoms, functional status and quality of life, provide healthcare professionals with data that were previously unavailable, and have fostered patient engagement, shared decision-making and adherence to treatment plans. We propose to explore an innovative solution to dental pain monitoring and management by implementing mobile phone technology to monitor patients' pain during the critical acute post-operative phase. We believe that by tracking patient reported outcomes (PROs) using mobile phones, patients with sub- optimal pain experiences will be easily identified. This study will demonstrate that PROs provide actionable data. This study can also serve as a model for implementing new health IT (mHealth) within dental practices to improve patient engagement. This observational study will be conducted at NDPBRN (Dental Practice-based Research Network) sites, which we believe are ideal for the development of this practical and focused post-operative pain management study. We will recruit 50 NDPBRN practices and 4050 patients who will receive push notifications through text messages using FollowApp.Care on their mobile phones at designated time intervals following their dental procedure. This innovative approach of implementing an existing and tested mHealth system technology (FollowApp.Care) into the real-world dental office setting of the NDPBRN will actively track pain and other complications following dental procedures. By patients using their mobile phones, we expect to promptly and precisely identify specific levels of pain for surgical dental procedures. During the UG3 phase of the study (Yr 1-2) we will develop all study materials in UG3-Aim1, and in UG3-Aim 2 develop the design features and workflow for implementation of the study. During the UH3 phase (Yr 3-6) we will in UH3-Aim1, pilot test procedures to streamline data collection and workflow in the NDPBRN dental office. In UH3- Aim 2 we will assess post-operative pain intensity by procedure type; in UH3-Aim 3 we will assess provider and patient post-op management strategies and in UH3-Aim 4, we will evaluate patients' and providers' acceptance of the mHealth technology.