Nav: Home

Pain doesn't take a holiday: Dental opioids study points to need for better prescribing

May 22, 2020

As dentists and their teams across America get back to their regular schedules after a sharp COVID-19-related reduction, a new study shows a key opportunity to reduce the use of opioid painkillers by their patients.

The
Teens and young adults were the most likely to get opioids, which were likely prescribed in order to get them through the weekend or holiday break without needing to contact the dentist for pain care.

One in five of the patients, all between the ages of 13 and 64, filled a prescription for an opioid, even though non-opioid pain medications are equally effective at controlling pain and have lower risks.

Those who had pre-weekend or pre-holiday procedures were 27% more likely to pick up an opioid prescription. If they were teens or young adults, they were 43% more likely than older patients to do so.

The new findings, reported in the Journal of the American Dental Association by a team from the University of Michigan, build on prior work showing overprescribing of opioids by dentists with no increase in pain relief or patient satisfaction .

The rate of weekend and holiday opioid prescription-filling by young people is especially troubling because of previous work showing that those who get opioids after getting their wisdom teeth out are nearly three times as likely to keep refilling the prescription long after their mouths should have healed.

"Variation in opioid prescription fills may put some patients at increased risk," says Caitlin Priest, the U-M Medical School student who led the analysis as part of the

Just over half of the patients whose records were analyzed had their dental procedure on an emergency basis. But the rest were scheduled - one-fifth of them on Fridays and the days before holidays.

Half of the patients who filled an opioid prescription had had scheduled surgical tooth extractions, but the pre-weekend and pre-holiday increase was seen across all 11 dental procedures studied.

This suggests multiple opportunities to reduce unneeded opioid prescribing, says Romesh Nalliah, M.H.C.M., D.D.S., the associate dean for patient services at the U-M School of Dentistry and a member of the study team. He notes that patients may seek Friday and pre-holiday appointments for their scheduled procedures to avoid missing work as they recover.

"The significance of our study is that, with the help of big data, it begins to unpack potentially harmful opioid prescribing trends that were not previously understood," he says. "In the event that we have particular concerns about a given case or patient, we can more deliberately book surgeries when we are available to follow-up."

The senior author of the paper, Chad Brummett, M.D., co-directs Michigan OPEN, which has published

The guidelines say that for dental extractions, non-steroidal anti-inflammatory medications and over-the-counter pain relievers should be sufficient for pain control.
-end-
Other studies have shown that educating patients about the risks of taking opioids, and the proper use of NSAIDs and other pain relievers, before their procedure can reduce opioid use without increasing their pain scores.

Michigan OPEN has created two free brochures for dental practices to give to patients - one about proper use of non-opioid pain medications, the other about appropriate use and risks from opioids. They are available at
https://michigan-open.org/patient-community-education/ .

Reference: JADA 2020:151(6):388-398, doi:10.1016/j.adaj.2020.03.014 The paper is featured on the cover of the journal's June issue.

Michigan Medicine - University of Michigan

Related Dentists Articles:

AI to make dentists' work easier
Finnish researchers have developed a new automatized way to localise mandibular canals.
Ouch: Patients prescribed opioids after tooth extraction report worse pain
The use of opioids to soothe the pain of a pulled tooth could be drastically reduced or eliminated altogether from dentistry, say University of Michigan researchers.
More than half of US opioid prescriptions for dental procedures exceeded 3-day supply recommendations from CDC 2016 guidelines
Dentists are among top prescribers of opioids in the US, however, whether their opioid prescribing exceeds guidance had not been investigated.
More than half of dental prescriptions for opioids exceed pain-management guidelines
A new study suggests that roughly half of the opioid prescriptions written by dentists in the United States exceed the 3-day supply recommended by federal dental pain-management guidelines.
How pipeline programs can increase diversity in dentistry
In 2012, 2 students at NYU College of Dentistry -- who are now both full-time faculty members -- set out to create a pipeline program for underrepresented and low-income high school students to boost their interest in health professions, including dentistry.
Most preventive antibiotics prescribed by dentists are unnecessary
A new study has found that 81% of antibiotics prescribed by dentists - who are among the top prescribers in the US, accounting for about 10% of all antibiotic prescriptions - to prevent infections prior to dental visits are unnecessary.
Antibiotics that dentists prescribe are unnecessary 81% of the time, research shows
Antibiotics prescribed by dentists as a preemptive strike against infection are unnecessary 81% of the time, according to a study published today in JAMA Network Open.
US dentists out-prescribe UK dentists when it comes to opioids
Researchers from the University of Illinois at Chicago have found that dentists practicing in the US write 37 times more opioid prescriptions than dentists practicing in England.
Oral cancer detection by dentists is significantly on the rise
After examining data gathered over an 11-year period in a first-of-its-kind provincial study, University of Toronto clinician-scientist Marco Magalhaes says that dentists in Ontario are detecting more cases of oral cancer and pre-cancer than ever before -- and it's saving lives.
Dentists can be the first line of defense against domestic violence
New findings indicate that oral biomarkers may help health providers identify victims of domestic violence.
More Dentists News and Dentists Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Clint Smith
The killing of George Floyd by a police officer has sparked massive protests nationwide. This hour, writer and scholar Clint Smith reflects on this moment, through conversation, letters, and poetry.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Nina
Producer Tracie Hunte stumbled into a duet between Nina Simone and the sounds of protest outside her apartment. Then she discovered a performance by Nina on April 7, 1968 - three days after the assassination of Dr. Martin Luther King Jr. Tracie talks about what Nina's music, born during another time when our country was facing questions that seemed to have no answer, meant then and why it still resonates today.  Listen to Nina's brother, Samuel Waymon, talk about that April 7th concert here.