Opioids not needed for dental pain, clinic’s research shows

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A dental clinic that stopped prescribing opioids reported in a medical journal Wednesday that its patients did fine, and that the decision most likely helped many patients steer clear of opioid abuse. Photo by Milenafoto/Wikimedia Commons

A dental clinic that stopped prescribing all opioids reported in a medical journal Wednesday that its patients managed pain well, and that the decision most likely helped many patients steer clear of opioid abuse.

The research letter compared prescribing patterns for opioid and non-opioid analgesics, along with patients’ dental pain outcomes, before and after the clinic began an opioid reduction initiative in 2013. It was published in JAMA Network Open.

“Considering that approximately 1,800 patients received more than 20,000 opioid pills annually in our clinic before implementation of the opioid reduction strategy, eliminating opioid prescriptions may mean that approximately 105 individuals annually will not develop new and persistent opioid use associated with treatment at our clinic,” the researchers said in their paper.

The study’s co-authors work at the Eastman Institute for Oral Health at the University of Rochester Medical Center in Rochester, N.Y.

To ease discomfort after dental procedures, such as tooth extraction, gum and other types of dental surgery, or the placement of dental implants, dentists may prescribe opioids along with other types of pain relievers, according to the National Institute of Dental and Craniofacial Research, a part of the National Institutes of Health.

Commonly prescribed opioids to treat dental pain include hydrocodone, oxycodone and acetaminophen with codeine, the institute says.

While the American Dental Association recommends non-steroidal anti-inflammatory drugs for pain management, opioids continue to be used more than alternatives, the researchers said.

This may be partly due to the lack of alternatives to opioids, especially when NSAIDs or acetaminophen are not appropriate for a patient or don’t work well, they said.

For their analysis, the researchers used prescription data from March 2021 to February 2022 and data from 2012 to represent patterns before the opioid reduction strategy.

The researchers retrieved information from patients’ electronic health records on routine or surgical tooth extractions; analgesics prescribed — whether a single medication, opioid combinations or analgesics, including ibuprofen, acetaminophen and gabapentin. They also reviewed follow-up visits for post-operative pain.

Those patients who returned to the clinic for additional pain treatment were considered as having failed to achieve pain relief. But the investigators acknowledged this is not an established way to test for effective pain management.

The study used the records of 3,357 patients — an even male-female split, with a mean age of 36, though participants’ ages ranged from 18 to 93 — who were prescribed analgesics after dental extractions in 2012.

And it was compared to a slightly larger number of records with similar demographics, from March 2021 to February 2022, a time period used to represent prescription patterns in 2022.

The researchers found the use of non-opioid, analgesic pain relief use was dramatically higher in 2022, accounting for 62.5% of patients; in 2012, such prescribing was used for only 0.2% of patients.

In 2012, 1,166 patients, or 34.7%, received opioid combination analgesics after extractions. In 2022, no patients received opioids; but 1,871, or 49.4% received acetaminophen or ibuprofen, and 496, or13.1%, received gabapentin analgesia.

No opioid prescriptions were recorded in 2022 after gabapentin was added to the prescribing strategy.

Acetaminophen or ibuprofen failed to control tooth-extraction pain 2.2% of the time, significantly below gabapentin-acetaminophen’s 4.1% failure rate and gabapentin/ibuprofen’s 5.9% failure rate.

Opioids overall failed to provide effective pain relief 21.4% of the time, though some opioid/analgesic combinations did better than others.

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