Study Warns of High-Risk Medicines in Children’s Dentistry

By Theresa Ahearn

In most pediatric dental practices, pain after a filling or extraction is expected to be brief and manageable. Local anesthesia combined with non-opioid medications such as ibuprofen or acetaminophen is usually sufficient to control postoperative discomfort. In a small fraction of cases, opioids or sedatives may be prescribed for complex procedures or highly anxious patients. New national data suggest that even this limited exposure can carry meaningful risks for children.

Researchers writing in the Journal of the American Dental Association analyzed more than 37 million pediatric dental visits between 2014 and 2019. They found that 0.72 percent involved a high-risk medication, defined as an opioid or benzodiazepine. While prescribing rates were low, adverse outcomes within this group were notable. Among children who received these medications, 4.3 percent had an emergency department visit, hospitalization, or urgent care visit within seven days of their dental appointment. Risk was highest among children who received opioids specifically. Within this subgroup, approximately one in ten experienced an opioid-attributable outcome, including overdose or continued opioid use months after the initial dental visit.

Routine Care Risks

Using national insurance claims data, the study examined how pain and sedation medications were prescribed and how outcomes varied by age, medical complexity, procedure type, expected pain level, drug class, and care setting. Outcomes included emergency department visits, hospitalizations, opioid overdose, and persistent opioid use.

Although high-risk prescribing was uncommon overall, it was not limited to rare or complex procedures. More than half of high-risk prescriptions were written during visits involving limited or mild pain. Nearly 30 percent were associated with procedures classified as limited pain, such as routine extractions or restorative care, and an additional 23 percent occurred during visits categorized as mild pain. These are situations in which dental pain is typically well controlled with local anesthesia and non-opioid analgesics.

Younger children experienced the greatest vulnerability. Compared with adolescents, children ages nine to eleven had 56 percent higher odds of an emergency department visit or hospitalization after receiving a high-risk medication. For opioid-specific outcomes, risk was highest among the youngest patients: children ages four to five had nearly 50 percent higher odds of overdose or persistent opioid use than teenagers.

Children with complex chronic or neurologic conditions were also disproportionately affected. In this group, exposure to opioids or benzodiazepines was associated with more than double the odds of short-term medical complications compared with children without these conditions.

Among children who experienced an opioid-attributable outcome, more than 70 percent continued filling opioid prescriptions one to three months after their dental visit, and nearly 30 percent continued filling prescriptions between three and twelve months after treatment. This extended use occurred well beyond the period when dental pain would typically be expected to resolve.

Where Children Are Treated Can Shape Outcomes

Prescribing patterns and outcomes also varied by care setting. Hospital-based and ambulatory surgery center settings more often treated medically complex children and were more likely to use opioids or benzodiazepines during major procedures or deep sedation. These settings showed higher rates of short-term emergency department visits and hospitalizations.

At the same time, hospital-based care was associated with lower long-term opioid-related harm. Compared with outpatient dental offices, children treated in hospitals or surgery centers were approximately 30 percent less likely to experience opioid overdose or persistent opioid use. The authors suggest this difference may reflect standardized dosing, closer physiologic monitoring, and routine use of multimodal non-opioid pain management protocols in these settings.

Pediatric Pain Guidelines

The findings closely align with guidance from the American Academy of Pediatric Dentistry, which emphasizes evidence-based, non-opioid approaches to managing pediatric dental pain. According to the AAPD, most dental pain in children can be prevented or effectively treated without opioids. The organization also advises against the use of codeine and tramadol, which are restricted by the U.S. Food and Drug Administration in children because of serious safety concerns.

Despite this guidance, the analysis found that among children younger than 12 who received opioids, more than 60 percent were prescribed codeine-containing products. This gap highlights ongoing challenges in translating pediatric pain management policy into everyday clinical practice.

Reducing Risks in Everyday Practice

For dental professionals, the takeaway is not to withhold pain relief but to rely on safer, effective options that are already available. The JADA data show that when opioids are prescribed, roughly one in ten children experiences measurable harm. Making multimodal non-opioid analgesia the default approach, coordinating care closely for medically complex patients, and using standardized pain management protocols can reduce avoidable risk while still providing effective pain control.

References:

1. Dental Tribune International. (2026, January 2). High-risk medicines in children’s dentistry raise safety concerns, study finds. https://www.dental-tribune.com/news/high-risk-medicines-in-childrens-dentistry-raise-safety-concerns-study-finds/
2. Liu, Y., et al. (2025). High-risk medications in pediatric dentistry. Journal of the American Dental Association, 156(12), 1001–1013.e13.
3. American Academy of Pediatric Dentistry. (2022). Policy on pediatric dental pain management. https://www.aapd.org/research/oral-health-policies--recommendations/acute-pediatric-dental-pain-management/

Author: Theresa Ahearn is a freelance writer who lives in Oak Ridge, Tennessee. She received her Bachelor of Arts from the New York Institute of Technology and her Master of Science from Central Connecticut State University. When not writing, she can be found fishing or traveling.