11 October 2022

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Are opioid prescriptions necessary after a tooth extraction?

Simona Chirico

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Although non-opioid analgesics such as paracetamol and ibuprofen are recommended as the first choice for dental pain, many dentists prefer to prescribe opioids. This is concerning due to the risk of abuse of opioids especially by younger people. 

A better understanding is needed of when it is necessary to prescribe these types of drugs to allow dentists to properly administer them to patients. 

Materials and methods 

A study by Oyler et al., published in the Journal of the American Dental Association, investigated how many opioid prescriptions were written after teeth extractions at the University of Kentucky College of Dentistry from 2013 to 2020. 

Results 

Data were obtained from 44,387 patients of whom nearly 24%, or 10,628 patients, received an opioid prescription. 

The results of multivariate logistic regression found that factors associated with prescribing an opioid included co-prescribing non-opioid analgesics, co-prescribing antibiotics, procedural sedation, surgical extraction and extractions of third molars (1 tooth: aOR, 1.14; 95% CI 1.04 to 1.25; 2 teeth: aOR, 2.09; 95% CI, 2.87 to 2.34; 3 teeth: aOR, 2.73 ; 95% CI, 2.36 to 3.15; 4 teeth: aOR, 3.45; 95% CI, 3.10 to 3.83). 

Factors that reduced the risk of opioid prescribing included whether or not the dental treatment was: performed in 2018 or later, in a student or university clinic resident and on any day other than Friday.  

Legislation that regulated and restricted the prescription of opioids went into effect in 2018 in the U.S. (Monday: aOR, 0.83; 95% CI, 0.76 to 0.91; Tuesday: aOR, 0.90; 95% CI, 0.83 to 0.99; Wednesday: aOR, 0.89; 95% CI, 0.81 to 0.97; Thursday: aOR, 0.88; 95% CI, 0.81 to 0.97) . 

Conclusions 

From the data outlined in this study, it can be concluded that opioids are  prescribed by dentists after the most invasive procedures surgical extractions — sedation extractions, multiple tooth extractions — in conjunction with other prescriptions — antibiotics and anti –inflammatory drugs — and on certain days of the week (mainly Fridays). 

This research suggests that dentists actively consider a variety of procedural features to guide their opioid prescribing decisions, rather than just routinely prescribing them. 

Clinical implications 

Improving the understanding of post-operative pain can facilitate the reduction of unnecessary opioid prescriptions, which can lead to the misuse, abuse and overdose of these drugs, especially by younger people. 

It is advisable for dentists to limit the prescription of opioids only following particularly invasive procedures. 

“Factors influencing opioid prescribing after tooth extraction.” Douglas R. Oyler et al. JADA vol. 153, Issue 9, p868-877, DOI: https://doi.org/10.1016/j.adaj.2022.05.001