Share on Pinterest
Dentists have the highest percentage of any medical professionals when it comes to prescribing opioid pain relievers to children.
Javier Zayas Photography/Getty Images
  • Researchers say nearly half of dentists still regularly prescribe opioid medications for pain management, especially to children.
  • That’s despite the fact most dentists are aware that other, less habit-forming drugs are just as effective as opioids.
  • Dentists say their profession is becoming more aware of the need to prescribe safer alternatives to manage post-dental pain.

Most dentists know that there are non-opioid pain relievers that are just as effective for managing dental pain as opioid drugs such as OxyContin, Percocet, and Vicodin.

Yet, many still prescribe opioid drugs to their patients, particularly young ones, a trend that can open the door to potential misuse, diversion, and addiction, a new study from The Journal of the American Dental Association (JADA) finds.

A survey of 269 dentists conducted by the PharmedOut program at Georgetown University Medical Center reported that 84 percent of respondents believe that a combination of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen combined with acetaminophen are equally effective or more effective than opioids.

But 43 percent of respondents still reported regularly prescribing opioid medications, researchers said.

Half of the dentists who reported prescribing opioids prescribed the drugs in amounts that would result in unused medication, the survey found, and 69 percent reported having patients divert or misuse opioids.

“These results suggest that dentists are familiar with the evidence about the effectiveness of NSAID-acetaminophen medications, but their self-reported prescribing patterns demonstrate a disconnect,” said Matthew Heron, the study’s first author who conducted the research as an undergraduate at Georgetown’s School of Nursing & Health Studies.

“A growing body of research supports ADA policy that dentists should prescribe NSAIDs alone or in combination with acetaminophen over opioids as first-line therapy,” according to a statement from the American Dental Association (ADA). “The ADA remains focused on assisting dentists with the best practices to help patients manage acute pain and relieve short-term dental pain without prescribing opioids.”

The researchers reported that dentists comprise about 8 percent of all opioid prescriptions written in the United States but are the highest prescribers of opioids to patients 18 years and younger.

“We know that the first exposure to opioids for many people occurs in their teens and early 20s following common dental procedures like third molar extractions,” said Nkechi Nwokorie, a study co-author and an analyst at Deloitte Consulting in Washington, D.C. “This is a particularly vulnerable population for misuse.”

Dr. Adriane J. Fugh-Berman, director of the PharmedOut project, said the findings point to the need for better education of dentists about the potential harms of opioid pain relievers.

Opioids were involved in 49,860 overdose deaths in 2019, according to the Centers for Disease Control and Prevention (CDC), with most deaths involving synthetic opioids.

Dr. Greg Grillo, a dentist in Washington and spokesperson for Express Dentist, told Healthline that there are certain dental procedures where opiates are better suited for pain relief.

“Dentists and oral surgeons remove about 10 million wisdom teeth every year, and 85 percent of people undergo this procedure,” said Grillo. “The vast majority occur during the teen years and involve invasive surgery, including incisions and jawbone removal. For many of these patients, initial pain management may include opiate pain relievers… The removal of impacted wisdom teeth is an invasive surgical procedure, and judicious use of opiates may be the best way to manage this level of pain.”

However, said Grillo, “Practitioners today are far more aware of the habit-forming nature of these medications than in the past, and we look for alternatives whenever possible.”

Dr. Joseph Salim, owner of Sutton Place Dental Associates in New York, told Healthline that he has “never prescribed any opiates to anyone under 18 years old in nearly 30 years of practice.”

“It is pretty much unnecessary to do so since they are very habit-forming,” said Salim. “I hardly ever prescribe it to adults either, since most dental procedures, even minor surgeries when using lasers, don’t engender [much] post-operative pain. I usually recommend the patients to take 2 Tylenols and 2 Advils as acetaminophen and ibuprofen. Each targets a different pain pathway and when taken together, they are 20 percent more effective than either one alone.”

Dr. Peter Franco, an oral surgeon with the Carolinas Centers for Oral, Facial, Cosmetic & Dental Implant Surgery, told Healthline that he uses the non-opioid pain reliever Exparel — an injectable, long-acting local anesthetic — to treat most pain related to dental surgery.

Using Exparel has reduced Franco’s prescribing of opioid pain relievers by 75 to 90 percent in the past few years, he estimated.

“For the majority of maxillofacial surgeries you can administer Exparel,” said Franco. “It’s been a fantastic tool.”