Dental Pain May Lead to First Encounter with Opioids
Dental pain may affect patients of all ages and notably may lead to the first encounter with opioids for adolescent and young adult populations. Dentists have historically represented the largest source of opioid prescriptions for this young age group, often for third molar extractions, and persistent opioid use following an initial prescription from a dental clinician has been identified in this age cohort.,
Dental Pain May Be Treated by Other Clinicians, Too
In one study, emergency department-administered opioid prescriptions for dental pain were associated with an increased likelihood of persistent or high-risk opioid use.
A recent study examining visits to outpatient clinics and emergency departments by adolescents aged 13-17 years old and young adults aged 18-22 years old found that 14.9% of ED visits were associated with an opioid prescription, with opioid prescribing rates highest for dental disorders (59.7% and 57.9% respectively) . Another study found that 13.6% of visits to non-dentist facilities for dental pain by children aged 18 years or younger were linked to opioid prescriptions over 3 days in length, with a mean daily dosage of almost 37 MMEpdf icon.
Nearly 60% of adolescents and young adults who visited an emergency department for a dental disorder were prescribed opioids.
Too Many Pills, Too Many Times
Visits to non-dentist facilities for dental pain by adolescents were linked to opioid prescriptions over 3 days in length, with a mean daily dosage of almost 37 MME.
Summary of Treatment Recommendations
“Dentists should consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management … [and]should recognize multimodal pain strategies for management for acute postoperative pain as a means for sparing the need for opioid analgesics.”
“Prescribe non-opioid analgesics as the FIRST line of pain control for dental procedures. Prescribe combinations of non-steroidal anti-inflammatory drugs (NSAIDsexternal icon) and acetaminophen following dental procedures where post-operative pain is anticipated, unless there are contraindications.
If use of an opioid is warranted,
- Follow the CDC guidelines: ‘Clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.’
- Prescribe opioids IN COMBINATION with first-line therapy. Avoid multiple acetaminophen-containing preparations concomitantly.
- For adolescents and young adults through 24 years old who are undergoing minor surgical procedures (e.g., third molar extractions), limit opioid prescriptions to 8-12 tablets.”
 Volkow ND, McLellan TA, Cotto JH et al. Characteristics of Opioid Prescriptions in 2009. JAMA 2011;305:1299-301.
 Harbaugh CM, Nalliah RP, Hu HM et al. Persistent Opioid Use After Wisdom Tooth Extractionexternal icon. JAMA. 2018 Aug 7;320(5):504-506.
 Schroeder AR, Dehghan M, Harbaugh CM, Newman TB et al. Association of Opioid Prescriptions from Dental Clinicians for US Adolescents and Young Adults with Subsequent Opioid Use and Abuse. JAMA Intern Med. 2019 Feb 1;179(2):145-152.
 Meisel ZF, Lupulescu-Mann N, Charlesworth CJ et al. Conversion to Persistent or High-Risk Opioid Use After a New Prescription from the Emergency Department: Evidence from Washington Medicaid Beneficiaries. Ann Emerg Med. 2019 Nov;74(5):611-621. doi: 10.1016/j.annemergmed.2019.04.007. Epub 2019 Jun 20.
 Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Trends in Opioid Prescribing for Adolescents and Young Adults in Ambulatory Care Settings. Pediatrics. 2019 Jun;143(6).
 Mikosz CA, Zhang K, Haegerich T, Xu L, Losby JL, Greenspan A, Baldwin G, Dowell D. Indication-Specific Opioid Prescribing for US Patients with Medicaid or Private Insuranceexternal icon, 2017. JAMA Network Open. 2020;3(5):e204514. doi:10.1001/jamanetworkopen.2020.4514