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Opioid Prescribing in Dental Medicine

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July 14, 2021

Dental medicine and the opioid epidemic

The United States is in the middle of an opioid epidemic. Opioid dependence rates have never been higher, with 4.3 million people abusing prescription opioids in 2014. We often think of medical physicians as the biggest culprits in overprescribing, but opioids are also commonly used in dental medicine. Dental prescriptions constitute 10% of all opioid prescriptions in the US and have been steadily rising since 1996. Compared to other developed countries, dental opioid prescriptions are 37 times higher in the US. Moreover, up to 92% of opioids prescribed to dental patients go unused. This means more prescriptions in the home that can be potentially misused by patients or other household members. 

Acute and postoperative dental pain management

These statistics are even more surprising when we consider that guidelines from the American Dental Association (ADA) still recommend non-steroidal anti-inflammatory drugs (NSAIDs), not opioids, as first-line for dental pain. Several high-quality studies illustrate that non-opioid analgesics are equally effective as opioids in managing dental pain. Yet, some dentists are still routinely prescribing opioids after any procedure without trying NSAIDs first. Even when opioids are necessary, the CDC recommends prescribing opioids for a duration of not more than three days. Despite this, dental opioid prescriptions often far exceed the recommended three-day courses. 

Dentists also prescribe opioids for dental pain in younger populations, increasing the risk of exposure to opioids at younger and younger ages. Last year, 3.5 million teens and young adults were introduced to opioids when they were prescribed Vicodin, a combination of hydrocodone and acetaminophen, following wisdom teeth removal. The younger a patient is exposed, the greater the lifetime risk of developing an opioid use disorder. 

Opioid prescription guidelines

To combat these issues, the Center for Disease Control and Prevention (CDC) created guidelines for managing dental pain while still using opioids responsibly in association with the ADA. As previously mentioned, they recommend using either NSAIDs or acetaminophen as first-line drug therapy regardless of the intensity of acute dental pain in both the non-operative and postoperative settings. If NSAIDs are problematic due to a risk for postoperative bleeding, other strategies can be used before resorting to opioids. For example, postoperative injections of long-acting anesthetics such as bupivacaine can be used to mitigate the risk of bleeding and make NSAIDs safer for use.

The guidelines also re-emphasize that opioids should only be used for short courses (three days or less). For patients on chronic opioids, decisions to use additional opioids prior to dental work or for acute dental pain should be jointly managed by dentists in conjunction with a patient’s long-term opioid prescriber. Like physicians, dentists should be accessing state-specific Prescription Drug Monitoring Programs (PDMP) prior to prescribing. Just like medical physicians, dentists should be encouraged to communicate openly with their patients about the risks of these medications before prescribing them. 

With the implementation of national ADA guidelines, responsible prescribing of opioids within the dental field is improving, but we must continue to address the overuse of opioids in both the medical and dental professions if we are to continue to tackle this epidemic. 

If you or someone you know might be struggling with discontinuing the use of prescription opioids, we can help. Start your journey to recovery from prescription opioids dependence today. Call us at (844) 943-2514 or schedule an appointment with our enrollment coordinators here.

Photo by Cedric Fauntleroy from Pexels


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