Background & Aims
Opioid analgesics are frequently used following a tooth extraction, despite non-opioid analgesics being the recommended first-line of treatment for acute post-procedure pain. Third molar extractions are among the main procedures leading to an opioid dental prescription and they are routinely performed in adolescents and young adults (AYA), a group at high risk for misuse and abuse of opioids. To date, most research has focused on opioid prescribing in academic settings, although most dental opioid prescriptions come from community practices. The aim of this study was to compare the opioid prescribing rate to AYA between academic and community dental practices and to identify factors associated with an opioid prescription.
Methods
De-identified demographic, procedural, and prescription information was pulled from the electronic health record of 7 dental practices (3 academic and 4 community) during a 5-month period (June 2022 to November 2022). Descriptive statistics and multivariable logistic regression analyses were conducted to identify factors leading to an opioid prescription.
Results
Of the 1,514 visits examined, community dental practices accounted for 72.8% of the visits and had higher rates of opioid prescribing to AYA when compared to academic settings (97.6% vs 78.6%, p<0.001). Patients receiving surgical extractions (OR=5.50, 95% CI: 3.17 – 9.48), having four or more teeth extracted (OR=2.66, 95% CI: 1.73 – 4.14)., and undergoing the procedure in a community practice (OR=9.49, 95%CI: 6.01-15.44) were more likely to receive an opioid prescription.
Conclusions
Opioid prescribing to AYA is common and significantly more prevalent in community settings. The findings from this study highlight the need to develop interventions that can be applied across practice settings to increase evidence-based analgesic prescribing to this high-risk population.
References
Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in
2009. JAMA. Apr 6 2011;305(13):1299-301. doi:10.1001/jama.2011.401
Oyler DR, Miller CS. Patterns of opioid prescribing in an Appalachian college of dentistry. J Am Dent
Assoc. Mar 2021;152(3):209-214. doi:10.1016/j.adaj.2020.12.002
Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse. JAMA Intern Med. Feb 1 2019;179(2):145-152. doi:10.1001/jamainternmed.2018.5419
Bonar EE, Coughlin L, Roche JS, et al. Prescription opioid misuse among adolescents and emerging
adults in the United States: A scoping review. Prev Med. Mar 2020;132:105972.
doi:10.1016/j.ypmed.2019.105972
Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Prescription opioid use and misuse among
adolescents and young adults in the United States: A national survey study. PLoS Med. Nov
2019;16(11):e1002922. doi:10.1371/journal.pmed.1002922
Pruskowski J, Childers J, Moore PA, et al. Managing Acute Pain and Opioid Risks Following Wisdom
Teeth Extraction: An Illustrative Case. MedEdPORTAL. Nov 22 2019;15:10855. doi:10.15766/mep_2374-
8265.10855
Hersh EV, Saraghi M, Moore PA. Dangers of Opioid Prescribing for Young Adults After Dental
Procedures. JAMA Intern Med. Jul 1 2019;179(7):997-998. doi:10.1001/jamainternmed.2019.0185
American Academy of Oral and Maxillofacial Surgeons. White paper: Opioid prescribing: Acute and
postoperative pain management. 2017. Accessed 5/3/22. Available at:
https://www.aaoms.org/docs/govt_affairs/advocacy_white_papers/opioid_prescribing.pdf