Dental care providers have significantly reduced the number of opioid prescriptions after oral surgery procedures over a 10-year period, according to a study published in January in the Journal of the American Dental Association.
It not only may reflect a transition toward alternative pain management, the reduction in prescribed opioids may demonstrate the successful implementation of ADA recommendations, the authors wrote.
"The substantial decrease in prescribed opioids across all study sites and cohorts indicates a positive shift toward alternative nonopioid pain management strategies in dental practice," wrote the authors, led by Dr. Steven J.D. Zbarsky, MPH, of the Loma Linda University School of Dentistry (JADA, January 15, 2025).
In the U.S., between 1999 and 2019, more than 600,000 people died from opioid overdoses, with nearly 280,000 of these deaths involving prescription opioids, prompting the government to declare the opioid epidemic a public health emergency in 2017. In response, dental clinicians, particularly oral and maxillofacial surgeons, have been encouraged to adopt nonopioid pain management practices, they wrote.
This retrospective study analyzed data from 3,710 adult patients who underwent ambulatory surgical nonimpacted and impacted tooth extractions under general anesthesia or sedation between January 2011 and December 2021, according to the study.
Opioid prescriptions were standardized by converting them into total morphine milligram equivalents (MMEs) for each patient, allowing for direct comparisons of opioid potency across prescriptions. The total MMEs were analyzed from 2011 to 2016 and 2017 to 2021.
The overall average MMEs prescribed per patient dropped significantly from 143.01 between 2011 and 2016 to 72.09 between 2017 and 2021 (p < 0.001). For the nonimpacted tooth extraction cohort, mean MMEs decreased from 132.41 in the earlier period to 64.70 in the later period (p < .001), they wrote.
Furthermore, a similar trend was observed in the impacted tooth extraction cohort, wherein mean MMEs declined from 147.69 between 2011 and 2016 to 73.96 between 2017 and 2021 (p < 0.001). The findings indicate a substantial reduction in opioid prescriptions across both cohorts over time.
However, the study had limitations. Nonopioid prescribing patterns were not assessed, leaving it unclear whether both opioid and nonopioid prescriptions declined or if nonopioid use increased as opioid use decreased, the authors added.
"These findings not only highlight successes regarding the implementation of recommendations from the ADA, but also underscore the importance of continued efforts to optimize pain management in the interest of patient safety," they concluded.
