Dentists commonly over-prescribe opioids

(Reuters Health) - More than half of the opioid prescriptions written by U.S. dentists between 2011 and 2015 exceeded current government guidelines for treating pain associated with dental procedures, a new study suggests.

In an analysis of nearly 550,000 dental visits by adults, researchers found that opioid prescriptions were written for more than the three-day maximum recommended by the Centers for Disease Control and Prevention, according to the report in the American Journal of Preventive Medicine.

Moreover, the study found patients often received prescriptions for higher doses than they needed.

“About one in 10 opioid prescriptions in the U.S. are written by dentists,” said study leader Katie Suda of the University of Pittsburgh School of Medicine. “But up until recently, dentists have not been included in the public conversation which is focused on finding solutions to the opioid epidemic.”

Among patients most likely to receive inappropriate prescriptions for opioids were those aged 18 to 34 and men, the groups most at risk of an opioid-related overdose, Suda said.

She hopes the new findings will spur professional organizations and public health groups to improve guidelines for prescribing opioids for oral pain.

A 2019 study by Suda and colleagues found U.S. dentists were 37 times more likely to prescribe an opioid for oral pain than British dentists (

To take a closer look at the prescribing habits of U.S. dentists, Suda and her colleagues turned a national database with information on patients whose dental care and prescriptions are covered by insurance.

The researchers turned up more than 1.4 million dental visits at which adults were given an opioid prescription. They focused on 542,598 visits between 2011 and 2015.

In 29.6% of the visits examined, dentists prescribed opioids even though pain after the procedure was expected to be mild, the researchers report. Moreover, in 29.3% of cases, opioid dosages exceeded what is recommended. Those higher dosages were more likely to occur in men and patients between the ages of 18 and 34 than in women and older people.

Although the CDC guidelines didn’t come out until 2016, there was ample dental literature published before then suggesting caution in prescribing opioids, Suda and colleagues note.

“This is a really important study,” said Dr. Anita Gupta, an anesthesiologist, pharmacist and clinical professor at the Rowan University School of Osteopathic Medicine in Stratford, New Jersey, and a member of the communications committee of the American Society of Anesthesiologists.

“This is an ongoing issue,” Gupta said. “Dentists are an important specialty that gets a lot of patients and this is an area that doesn’t get a lot of attention.”

The new research should be “a call to action,” Gupta said. “It’s an opportunity to develop policy to advocate for best practices. It’s also an example of clinicians needing better education on how to prescribe opioids better.”

That doesn’t mean there is no role for opioids in controlling dental pain, Gupta said. But their use should be of a short duration.

For many patients, nonsteroidal anti-inflammatory drugs would be a good choice because along with pain relief, these medications knock back inflammation associated with the dental procedure, Gupta said.

“As a pharmacist I’ve been trained to give the lowest effective dose for the shortest period of time,” Gupta said.

SOURCE: American Journal of Preventive Medicine, online February 4, 2020.