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High percentage of patients prescribed opioids following tooth extraction

In a study published online by JAMA, Brian T. Bateman, M.D., M.Sc., of Brigham and Women’s Hospital, Boston, and colleagues examined nationwide patterns of opioid prescribing following surgical tooth extraction.

Opioid abuse has reached epidemic proportions in the United States, and often begins with a prescription for a pain medication. Dentists are among the leading prescribers of opioid analgesics, and surgical tooth extraction is one of the most frequently performed dental procedures. Surveys suggest that dental practitioners commonly prescribe opioids following this procedure, despite evidence that a combination of nonsteroidal medications and acetaminophen may provide more effective treatment for postextraction pain.

The researchers collected data from a national database of health claims drawn from Medicaid transactions for the years 2000-2010. All patients who underwent surgical dental extraction were included. The frequency of opioid prescriptions filled within 7 days of extraction was determined, as was the nature and amount of opioids dispensed.

The analysis included 2,757,273 patients. Within 7 days of extraction, 42 percent of patients filled a prescription for an opioid medication. The most commonly dispensed opioid was hydrocodone (78 percent of all prescriptions), followed by oxycodone (15 percent), propoxyphene (3.5 percent), and codeine (1.6 percent). Patients age 14 to 17 years had the highest proportion who filled opioid prescriptions (61 percent), followed by patients age 18 to 24 years.

There was great variability in the amount of opioids dispensed for a given procedure, with an approximately 3-fold difference between the 10th and 90th percentile in the oral morphine equivalents prescribed. “Although a limited supply of opioids may be required for some patients following tooth extraction, these data suggest that disproportionally large amounts of opioids are frequently prescribed given the expected intensity and duration of postextraction pain, particularly as nonopioid analgesics may be more effective in this setting,” the authors write.

“This common dental procedure may represent an important area of excessive opioid prescribing in the United States. As the nation implements programs to reduce excessive prescribing of opioid medications, it will be important to include dental care in these approaches.”