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Michigan OPEN
Michigan OPEN
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OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.

Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families

Chua KP, Kenney BC, Waljee JF, Brummett CM, Nalliah RP. Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families. American Journal of Preventive Medicine. Published online 29 April 2021. DOI: 10.1016/j.amepre.2021.02.008
  • Initial opioid prescriptions after dental procedures were associated with a higher risk of opioid overdose in patients.
  • The magnitude of increased risk was greater in patients who were publicly insured and in patients who had mental health or substance use disorders. Among privately insured patients in family plans, initial opioid prescriptions after dental procedures were associated with a higher risk of overdose in patients’ family members.
  • These findings highlight the importance of avoiding unnecessary dental opioid prescribing.

Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018

Chua KP; Hu HM; Waljee JF; Nalliah RP; Brummett CM; Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018. JAMA Network Open. Published online 16 April 2021. DOI: 10.1001/jamanetworkopen.2021.6464
  • Persistent opioid use was defined as 1 or more dispensed opioid prescriptions 4 to 90 days after the index date and 1 or more prescriptions 91 to 365 days after the index date. Overall POU was 1.3%, and the risk of POU was higher among publicly insured (2.0%) than privately insured patients (0.9%).
  • The initial dental opioid prescriptions were associated with a 1.0–percentage point higher risk of POU among publicly insured patients compared with privately insured patients.
  • The results further highlight the importance of avoiding dental opioid prescribing when nonopioids provide effective analgesia, which is the case for most dental procedures.

Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018

Chua KP; Hu HM; Waljee JF; Brummett CM; Nalliah RP. Opioid prescribing patterns by dental procedure among US publicly and privately insured patients, 2013 through 2018. JADA. Published online 23 February 2021. DOI: https://doi.org/10.1016/j.adaj.2021.01.001
  • Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of total prescriptions.
  • Opioid prescribing for tooth extractions is declining but remains common, despite the availability of equally effective nonopioid alternatives.
  • Eliminating routine opioid prescribing for tooth extraction could reduce dental opioid exposure substantially.

Increased opioid prescription fills after dental procedures performed before weekends and holidays

Priest CR, Kenney BC, Brummett CM, Waljee JF, Englesbe MJ, Nalliah RP. Increased opioid prescription fills after dental procedures performed before weekends and holidays. J Am Dent Assoc. 2020;151(6):388-398.e1. doi:10.1016/j.adaj.2020.03.014
  • Patients with dental procedures the day before weekends and holidays were more likely to fill an opioid prescription than patients with procedures on other weekdays, an odds ratio 1.27.
  • The odds of filling an opioid prescription for patients aged 13 to 29 were 1.43 times of the odds for patients aged 50-64 years.

Association of Opioid Use with Pain and Satisfaction After Dental Extraction

Nalliah RP, Sloss KR, Kenney BC, et al. Association of Opioid Use With Pain and Satisfaction After Dental Extraction. JAMA Netw Open. 2020;3(3):e200901. Published 2020 Mar 2. doi:10.1001/jamanetworkopen.2020.0901
  • Among patients who underwent surgical and routine extractions, patients who used opioids reported higher levels of pain compared with those who did not use opioids
  • No statistically significant difference in satisfaction was found between patients after surgical extraction who used and did not use opioids, and between those after routine extraction who used and did not use opioids.

Persistent Opioid Use after Wisdom Tooth Extraction

Harbaugh CM, Nalliah RP, Hu HM, Englesbe MJ, Waljee JF, Brummett CM. Persistent Opioid Use After Wisdom Tooth Extraction. JAMA. 2018;320(5):504-506. doi:10.1001/jama.2018.9023
  • Approximately 80% of patients who were not using opioids before wisdom tooth extraction filled an opioid prescription at the time of surgery.
  • Opioid prescriptions at the time of wisdom tooth extraction lead to a 3-fold increased odds of developing persistent opioid use in the year after surgery among adolescents and young adults.
  • Given the effectiveness of non-opioid analgesics, the practice of any routine opioid prescribing must be questioned in the face of the potential morbidity and long-term consequences of opioid use.