Opioids Ineffective Following Tooth Extraction, Researchers Say

Patients who received an opioid after tooth extraction reported higher levels of pain than patients who received a non-opioid, according to researchers from the University of Michigan. The study authors concluded that the use of opioids for a tooth extraction could be drastically reduced, or eliminated entirely, from dentistry.

The investigators asked 329 dental patients to rate their pain and satisfaction within 6 months following a tooth extraction. Approximately 50% of those who had surgical extraction and 39% who had a routine extraction were prescribed opioids.

The primary outcome was self-reported pain with a 4-point scale based on no pain, minimal pain, moderate pain, and severe pain. Secondary outcomes were self-reported satisfaction with care on a 10-point scale.

Their findings showed that patients who received opioids experienced significantly higher pain than others. In addition, roughly half of the opioids prescribed remained unused in both surgical and non-surgical extractions.

On the 4-point pain scale, the median for the surgical extraction opioid group was 3, compared with 2 for the nonopioid group. For the routine extraction group, the opioid group reported a median pain level of 3, compared with the nonopioid median of 2.

The percentage of patients in the routine extraction opioid group who reported concerns about pain was higher than those who did not receive opioids, but the difference was not statistically significant. There was also no statistically significant difference in the use of nonopioid analgesics between opioid and nonopioid users.

Satisfaction levels were high in both the routine and surgical extraction groups, regardless of whether they received an opioid or nonopioid analgesic.

The authors noted that opioid-related deaths in the United States increased by 16% from 2016 to 2017, and that the opioid crisis is the only public health issue in the United States with worsening associated mortality.

Dentists and oral surgeons have been under particular scrutiny for opioid prescribing practices, according to the authors. Between 2010 and 2016, new dental procedure-associated opioid prescriptions to opioid-naïve adult patients increased by 68%. Furthermore, the researchers noted that dentists are among the most common opioid prescribers for minor patients and that dental opioid prescriptions are often patients’ first exposure to the drug.

Among the patients who underwent a surgical tooth extraction, the median oral morphine equivalent prescribed was 60. When standardized to hydrocodone 5 mg, the median prescription was 12 pills. The median number of pills consumed was just 5, however, among the surgical extraction group. In the routine extraction group, the median number prescribed was 10, with a median of just 5.7 pills consumed.

According to the authors, earlier research has found that approximately 54% of opioids prescribed by dentists for surgical procedures went unused.

Based on their findings, the researchers recommended that nonopioid analgesics be prescribed instead of opioids after dental extractions for most patients.

REFERENCE

Nalliah R, Sloss K, Kenney B, Bettag S, et al. Association of Opioid Use with Pain and Satisfaction After Dental Extraction. JAMA Network Open; published March 13, 2020. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2762703. Accessed March 17, 2020.