Opioids Prescribed for Dental Pain Linked to Higher Risk of Overdose in Patients, Families

Overdose rates are significantly higher among patients who filled a prescription for an opioid following a dental procedure, according to researchers at the University of Michigan.

Investigators used data from 8.5 million dental procedures in teen and adult patients between 2011 and 2018 whose care was covered by Medicaid or private dental insurance. Nearly 27% of those patients filled a prescription for an opioid, such as hydrocodone or oxycodone. According to a press release, the investigators found that overdose rates were 2 and a half times higher among patients who filled the prescription, compared to patients who did not fill such an opioid prescription.

The investigators identified 2700 overdoses that occurred in the 90 days after a tooth extraction or 119 other dental procedures. That works out to approximately 3 overdoses for every 10,000 dental procedures, according to the study. Specifically, the rate was 5.8 per 10,000 among those who filled an opioid prescription within 3 days of their procedure, compared with 2.2 per 10,000 among those who didn’t.

According to the study, the risks are also higher among family members of patients who receive opioid prescriptions following a dental procedure. The researchers used data from 3.5 million privately insured dental procedure patients to examine overdoses within 90 days in the patients’ family members and found a rate of 1.7 overdoses per 10,000 procedures in family members of privately insured patients who filled opioid prescriptions, compared with 1 per 10,000 procedures among those who didn’t.

During the 90-day period after the dental patient’s procedure, 400 family members of patients were treated for opioid overdoses. In total, 42% of these overdoses were in the child of the patient who had a procedure, and another 25% were in the spouse. The rest were in parents and siblings.

“Our paper shows that when patients fill dental opioid prescriptions, the risk of opioid overdose increases both for themselves and their family members,” said Kao-Ping Chua, MD, PhD, who led the analysis, in the press release. “This underscores the importance of avoiding dental opioid prescribing when non-opioids like ibuprofen and acetaminophen are effective options for pain control, as is the case for the majority of dental procedures. Our finding of increased overdose risk in family members also shows the importance of emphasizing safe storage and disposal when prescribing opioids to dental patients.”

The authors noted that other research has shown that in 2016 alone, dentists wrote 11.4 million prescriptions for opioids. The new results suggest that 1700 overdoses per year could be happening because of dental opioid prescriptions, according to the current study.

“To me, this is one of the most powerful truths we’ve unlocked in our ‘big data’ research on dental opioid prescribing,” said senior author Romesh Nalliah, DDS, MHCM, in the press release. “That when a dentist, like me, prescribes an opioid to a patient I am putting their entire family at risk of overdose. Dentists should consider, if the family concerned was yours, would you take that risk?”

Finally, the study identified specific groups of patients who are at higher risk of opioid overdose after receiving opioid prescriptions. These groups include patients with diagnosed mental health conditions and substance use disorders, and those with Medicaid health coverage. This knowledge could help dentists and oral surgeons choose the correct treatment regimen for their patients, according to the study.

REFERENCE

Treating Dental Pain with Opioids Linked to Higher Risk of Overdose in Patients and Faily Members [news release]. Michigan Medicine; April 28, 2021. https://labblog.uofmhealth.org/rounds/treating-dental-pain-opioids-linked-to-higher-risk-of-overdose-patients-and-family-members. Accessed May 4, 2021.