Dental Pain and Opioid Use: Latest Findings

Editor's note: This article was updated July 26, 2018, to add detail about the American Dental Association’s interim policy on opioids.

The United States is battling a severe opioid epidemic, and prescriptions written to alleviate dental pain continue to play a part. In 2016, 11.5 million people misused opioids nationwide, and more than 42,000 died from opioid overdoses. Statistics show that dentists have written a declining portion of all opioid prescriptions in recent years, but two new studies highlight the continued need for cautious prescribing

One study published in April in The Journal of the American Dental Association (JADA) assesses prescribing patterns for dentists caring for patients with private insurance. The authors found that the rate of opioid prescriptions per 1,000 patients rose from 131 to 147 in 2010-15. The largest increase was among 11- to 18-year-olds, for whom the prescription rate grew by nearly two-thirds. For all age groups, nearly one-third of the opioid prescriptions written by dentists were for nonsurgical visits. The authors suggest that dentists could prescribe non-opioid pain relief in more of these instances.

Another study, also published in JADA in April, looks at Medicaid patients who sought outpatient dental care. The authors found that from 2013 to 2015, almost a quarter of such patients filled an opioid prescription. Emergency department (ED) health care providers were much more likely to prescribe opioids to patients with dental conditions; 38 percent of patients who received care in the ED filled an opioid prescription, compared with 11 percent who went to the dentist. The data suggest that emergency health care practitioners and dentists diagnose oral health problems differently, which can lead to unnecessary opioid use.

These studies underscore opportunities to reduce inappropriate prescribing of opioids while still ensuring that patients have access to effective pain management. For instance, a 2016 statement from the American Dental Association (ADA) on the use of opioids in treatment recommends that dentists prescribe nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain.

More recently, the ADA released an interim policy in March that supports mandatory continuing education for dentists on prescribing opioids. The policy also backs statutory limits on opioid dosage and duration consistent with Centers for Disease Control and Prevention guidelines, meaning prescriptions for no more than seven days. In addition, the ADA interim policy calls for dentists to take advantage of state prescription drug monitoring programs, which can help inform prescribing decisions and stem the misuse of prescription opioids.

Jane Koppelman directs research for The Pew Charitable Trusts’ dental campaign.