Dental Surgery

OPEN’s Opioid Prescribing Recommendations are designed to spark meaningful conversations between patients and providers, so every pain management plan is tailored to the individual. These recommendations are rooted in research, patient-reported outcomes, and expert consensus. They are intended for patients who haven’t used opioids before surgery. Explore OPEN’s evidence-based recommendations for safer prescribing after pediatric dental surgery below.

Learn more at michigan-open.org/prescribing-recommendations/.

Oxycodone
5mg Doses

Dental Extraction

SUPPORTING LITERATURE

Chung et al. 2018 (Level 3 evidence)

DOI: 10.1542/peds.2017-2156
Retrospective cohort study that analyzed the prevalence of and indications for outpatient opioid prescriptions and the incidence of opioid-related adverse events in children undergoing dental extraction at a single institution between 1999-2014.
1362503 outpatient opioid prescriptions; The annual mean prevalence of opioid prescriptions was 15%.
437 cases of opioid-related adverse events confirmed by medical record review; 88.6% were related to the child’s prescription and 71.2% had no recorded evidence of deviation from the prescribed regimen.
Adverse events increased with age and higher opioid dose. Adverse events accounted for 38.3% of prescriptions.

Chua et al. 2021 (Level 3 evidence)

DOI: 10.1016/j.amepre.2021.02.008.
Used IBM MarketScan Dental, Commercial, and Medicaid Multi-State Databases to analyze data from privately and publicly insured patients aged 13–64 years who underwent a dental extraction between 2011-2018. Included 8,544,098 procedures among 5,562,589 unique patients.
When ≥1 initial prescription did occur the 90-day risk of overdose was 5.8 per 10,000 procedures and the 90-day risk of overdose in a family member was 1.7 per 10,000 procedures.
When ≥1 initial prescription did not occur, the 90-day risk of overdose was 2.2 per 10,000 procedures and the 90-day risk of overdose in a family member was 1.0 per 10,000 procedures.

Moore & Hersh 2013 (Level 4 evidence).

DOI: 10.14219/jada.archive.2013.0207
Systematic review to determine the safety and analgesic efficacy of combining ibuprofen and N-acetyl-p-aminophenol (APAP).
Found that ibuprofen and APAP may be a more effective analgesic with fewer side-effects than current treatments for third molar extractions.
Number of doses of ibuprofen + APAP to treat pain = 1.6.

OPIOID PRESCRIBING

When an opioid is needed after surgery, use the OPEN prescribing recommendations as the foundation for a shared decision-making conversation with the patient to determine the best prescription size.

It’s important to note that these are not rigid rules that must be adhered to, but rather recommendations. Starting form a standardized approach and then allowing for individualization helps promote both equity and patient-centeredness.

Determine the opioid prescribing range based on:
- Type of procedure
- Additional procedures performed
With the patient, determine the best prescription size within the appropriate range
- Assess for individual risk factors
- Consider patient preferences and other non-opioid strategies utilized
- Pain management at the time of discharge:
  - Pain scores in 24 hours prior to discharge
  - Medication use in 24 hours prior to discharge
  - Timing of discharge