Use of Prescription Opioids to Treat Acute Dental Pain

After family physicians, dentists are among the top opioid prescribers in the U.S., writing 1 out of every 10 prescriptions for opioids.^1,2 These prescribing rates are significantly higher than rates in other countries with similar dental care practices. For example, one study found that dentists in the U.S. prescribe opioids at a rate 70 times higher than dentists in England.³

First Exposure to Opioids for Adolescents

Even more concerning is that dentists are the highest prescribers of opioids to patients 18 years and younger.⁴ This age group is especially vulnerable, because older adolescents and young adults are at the highest risk for initiation of opioid use, opioid misuse, opioid use disorder (OUD), and death from overdose.⁵

Research has shown that medical use of prescription opioids is highly correlated with non-medical or illicit use of opioids among high school seniors. Among adolescents who reported both types of use, medical use was generally how it started.⁶

For many adolescents and young adults, their first exposure to opioids is after wisdom-tooth removal.⁷ Dentists and oral surgeons remove about 10 million wisdom teeth every year, and 85% of people undergo this procedure during their lifetime.⁶

Non-Opioid Medications Are Just as Effective

According to the American Dental Association, non-opioid pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen should be considered the first choice for acute pain management.⁸ However, despite the fact that studies have shown that NSAIDs are as effective as or superior to opioid medications for controlling acute dental pain,⁹ dentists frequently recommend and prescribe opioids instead of NSAIDs.^10,11,12

Particularly concerning is that one study showed that more than half of the opioid prescriptions written by dentists were for longer than the three-day supply recommended by the Centers for Disease Control and Prevention (CDC) for acute dental pain. In addition, 29% of dental patients received more powerful opioids than needed after their dental procedures.⁸

Know Your Risk for Opioid Use Disorder

Dentists have an ethical and professional obligation to manage their patients’ pain without putting them at unnecessary risk for addiction. Because the risk of addiction is higher for some people than others, it’s important that you and your dentist understand your personal risk for opioid addiction (also called Opioid Use Disorder, or OUD) when use of prescription opioids is being considered.

There are many known factors associated with increased risk for opioid addiction, including your genetics.¹³ The good news is that thanks to recent scientific advances, dentists and patients now have a way to assess genetic risk for OUD before a prescription is written.

Make More Informed Decisions About Pain Management

AvertD™ is a clinically validated test that identifies an individual’s genetic risk for developing OUD. The test requires only a simple cheek swab sample and analyzes 15 genetic markers involved in the brain reward pathways associated with addiction to identify if a patient may have an elevated genetic risk for OUD.

When use of prescription oral opioids for acute pain is being considered, AvertD offers an objective way to identify who may have an elevated genetic risk for opioid addiction—so you and your provider can make more informed decisions about how to manage your pain safely and effectively.

Are you undergoing a dental procedure soon? Will an opioid be prescribed after the procedure? Do you know your risk for developing OUD?

If you or someone you love are scheduled for a dental procedure where oral opioids may be prescribed to manage acute pain (pain expected to last <30 days), you should consider taking the AvertD test. Learn more at https://avertdtest.com/for-patients/

Note: Because genetics are only one factor in understanding the risk of developing OUD from using oral opioids, AvertD test results should always be used in conjunction with a complete clinical evaluation to determine the appropriateness of oral opioids for pain management.

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Additional Resources:

• To view treatment recommendations from the CDC for acute dental pain, visit https://www.cdc.gov/acute-pain/dental-pain/index.html
• To learn more about the use of pain medication for acute dental pain from the American Dental Association, visit: https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-analgesics-for-acute-dental-pain
• To view the Indian Health Service’s recommendation for managing acute dental pain, visit: https://www.ihs.gov/newsroom/ihs-blog/may2019/ihs-introduces-recommendations-for-management-of-acute-dental-pain/

References:

¹L Rasubala, L Pernapati, X Velasquez, J Burk, YF Ren, Impact of a mandatory prescription drug monitoring program on prescription of opioid analgesics by dentists. PLOS ONE, 10 (8) (2015), Article e0135957. https://doi.org/10.1371/journal.pone.0135957

²ND Volkow, TA McLellan, JH Cotto, M Karithanom, SR Weiss. Characteristics of opioid prescriptions in 2009. JAMA, 305 (13) (2011), pp. 1299-1301 https://doi.org/10.1001/jama.2011.401

³KJ Suda, MJ Durkin, GS Calip, et al. Comparison of opioid prescribing by dentists in the United States and England. JAMA Netw Open, 2 (5) (2019), Article e194303. https://doi.org/10.1001/jamanetworkopen.2019.4303

⁴Dentists and Opioid Pain Relievers: Why They Prescribe So Many, Especially to Children: https://www.healthline.com/health-news/dentists-and-opioid-pain-relievers-why-they-prescribe-so-many-especially-to-children

⁵National Institutes of Health HEAL Initiative: https://heal.nih.gov/research/new-strategies/preventing-opioid-use-disorder

⁶McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015. Pediatrics. 2017;139(4):e20162387. https://doi.org/10.1542/peds.2016-2387. Accessed February 10, 2021.

⁷Indian Health Service, Division of Oral Health; Indian Health Service, National Committee on Heroin, Opioid and Pain Efforts. Recommendations for management of acute dental pain. Indian Health Service. https://www.ihs.gov/newsroom/ihs-blog/may2019/ihs-introduces-recommendations-for-management-of-acute-dental-pain/. Updated November 2020. Accessed February 10, 2021.

⁸Suda, K., Zhou, J., Rowan, S., McGregor, J., Perez, R., Evans, C., Gellad, W. and Calip, G., 2020. Overprescribing of Opioids to Adults by Dentists in the U.S., 2011–2015. American Journal of Preventive Medicine, 58(4), pp.473-486.

⁹Dionne RA, Gordon SM, Moore PA. Prescribing opioid analgesics for acute dental pain: Time to change clinical practices in response to evidence and misperceptions. Compend Contin Educ Dent. 2016;37(6):372-378.

¹⁰PA Moore, EV Hersh. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc, 144 (8) (2013), pp. 898-908. https://doi.org/10.14219/jada.archive.2013.0207

¹¹I Mutlu, AO Abubaker, DM Laskin. Narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons after impacted third molar removal. J Oral Maxillofac Surg, 71 (9) (2013), pp. 1500-1503. https://doi.org/10.1016/j.joms.2013.04.031

¹²JA Baker, J Avorn, R Levin, BT Bateman. Opioid prescribing after surgical extraction of teeth in Medicaid patients, 2000-2010. JAMA, 315 (15) (2016), pp. 1653-1654. https://doi.org/10.1001/jama.2015.19058

¹³Bevilacqua L, Goldman D. Genes and addictions. Clin Pharmacol Ther. 2009; 85(4):359–361. doi:10.1038/clpt.2009.6