The storm surrounding opioids as prescribed by dentists continues to swirl as a research letter published earlier this month in JAMA reports that prescribing opioids to teens and young adults who have their wisdom teeth extracted could set them on the path to long-term opioid use.

Wisdom Teeth X-ray

The research from a team led by Calista M. Harbaugh, MD, at the University of Michigan, found that patients, aged 13 to 30, were nearly 2.7 times more likely than their peers to still be filling opioid prescriptions weeks or months after having their wisdom teeth out.

Dr. Harbaugh and her colleagues reviewed the data on 56,686 patients who had their wisdom teeth extracted between 2009 and 2015, and found that 1.3 percent of them went on to “persistent opioid use,” which they defined as two or more prescriptions filled in the next year by any provider for any reason.

That was compared against 14,256 wisdom tooth patients who were prescribed an opioid – most commonly hydrocodone or oxycodone – but didn’t fill the perioperative prescription. Only 0.5 percent of these patients subsequently became persistent opioid users.

 

When taken together with the previous studies … dentists and oral surgeons should stop routinely prescribing opioids for wisdom tooth extractions and likely other common dental procedures.

 

Chad Brummet, MD
Chad Brummet, MD
Calista M. Harbaugh, MD
Calista M. Harbaugh, MD

While the percentage of patients who filled their prescriptions and became persistent opioid users is small, Dr. Harbaugh noted in a news release that the high number of wisdom teeth procedures every year means a large number of young people are at risk.

“When taken together with the previous studies … dentists and oral surgeons should stop routinely prescribing opioids for wisdom tooth extractions and likely other common dental procedures,” said Chad Brummett, MD, co-director of the Michigan Opioid Prescribing and Engagement Network (Michigan OPEN) in the news release issued by the University of Michigan. Dr. Harbaugh, the study lead, is a research fellow with Michigan OPEN.

Dr. Harbaugh acknowledges that her team’s research only represents opioid prescriptions that patients filled subsequent to their extractions, not actual use of the narcotics.

 

Nonopioid analgesics may have equivalent or superior efficacy for postextraction pain..

 

As the researchers wrote in JAMA:

“Limitations include that the amount of opioid prescriptions filled may not reflect actual consumption. The reasons for opioid prescriptions refills (e.g., whether for pain or a non-prescribed reason, storage for later use, or diversion to another person) were unknown.”

Nonetheless, Dr. Harbaugh concludes that dentists and patients should turn to nonsteroidal anti-inflammatories and other non-narcotics as their first line of defense against pain, only turning to opioids for “breakthrough pain,” if a patient’s discomfort can’t be controlled with other medications.

“Nonopioid analgesics may have equivalent or superior efficacy for postextraction pain,” the JAMA research letter notes.

One critic of Dr. Harbaugh’s study suggested that the results may be much ado about nothing.

“Is there something inherently bad about refilling opioid prescriptions and staying on opioids longer than the average person if one is not addicted?” asked Jeffrey A. Singer, MD, a fellow of the American College of Surgeons, and senior fellow in the Center for the Study of Science and the Department of Health Policy Studies at the Cato Institute. “Why are the authors so upset if some people stay on the drug longer than others?” he asked in an article on the Cato website.

The American Dental Association recently recommended an opioid prescribing limit of seven days or less, as well as continuing education for all dentist in prescribing opioids and other controlled substances.

The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.
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