Teens and adolescents are increasingly being prescribed painkillers for molar extraction and other dental procedures.
Adolescents and young adults who are prescribed opioids after dental work may be at risk of persistent use and abuse of these drugs.
A recent study published in JAMA Internal Medicine found that dental prescriptions for opioids for children and adolescents aged 11 to 18 increased from 99 patients per 1,000 in 2010 to almost 166 patients per 1,000 in 2015.
Almost one quarter of the opioid prescriptions for patients in this age group come from dentists.
Wisdom teeth extraction is a common source of prescriptions for opioids in this group. It is estimated the dental procedure is performed on approximately 5 million people in the United States every year.
“Most of this is driven by wisdom teeth extractions, and I think the frequency with which this procedure is performed warrants further evaluation. Third molar extractions can be painful, though there is some debate over whether opioids are always needed. Even when they are, one to two days’ worth are generally sufficient. As opposed to the median number of 20 prescribed in our study,” Dr. Alan Schroeder, author of the study and a pediatrician and professor at Stanford University School of Medicine, told Healthline.
Schroder and colleagues examined data from a large group of privately insured patients across the United States.
Of the nearly 15,000 young people who were given a prescription for opioids by their dentist in 2015, nearly 7 percent had another round of opioids prescribed between 90 days and 365 days after their initial prescription.
Nearly 6 percent were diagnosed with opioid abuse within 12 months of their initial prescription.
Of those who didn’t receive an opioid prescription from their dentist, only 0.1 percent received an opioid prescription later on and just 0.4 percent were diagnosed with opioid abuse.
Opioid abuse is a public health crisis in the United States.
According to the Centers for Disease Control and Prevention (CDC), overdoses from opioids are increasing across the United States for men and women in most age groups.
Deaths from opioid overdoses have more than tripled between 1999 and 2016.
More than 63,000 people died from drug overdoses in 2016 and more than 42,000 of those included overdoses from prescription or illegal opioids.
Public health experts argue the best way to combat the opioid crisis is to reduce opioid prescriptions to lower patient exposure to the drugs and prevent misuse.
“We’re really trying hard to indicate to doctors and dentists in particular that the evidence is pretty clear: for acute pain the non-opioids are as good in almost all cases and should be the medications of first choice,” Dave Preble, DDS, senior vice president of the American Dental Association (ADA) Practice Institute, told Healthline.
“The ADA and the dental profession is taking responsibility for its role, whether it’s the leading prescriber or not, either way we have to take responsibility for that role in opioid prescribing to this younger age group and we are determined to do something about it which is education of both the profession to use alternatives medications, and to the public,” he said.
Schroeder says there has been a growing awareness about the risks associated with prescribing opioids, particularly among the dental community.
“We must give the dental community credit, as there has already been a concerted effort to curb excessive prescribing, so I think if we repeated this study in 2018 the effect might be less dramatic. But the simple first step is to make sure patients are aware of these risks and then to try to prescribe only the minimum anticipated amount needed,” he said.
Although wisdom teeth extraction can be a painful procedure, many of the experts who spoke with Healthline said there were other non-opioid medications such as ibuprofen and acetaminophen that could treat post-surgical pain.
Sheila Brear, BDS, associate dean for academic affairs in the UCSF School of Dentistry, says there are still occasions where prescribing opioids to a teenager is appropriate, but such decisions should be made on a case-by-case basis.
“The decision as to whether or not to prescribe painkillers, and if so, what kind, has to be made on an individual basis, based on the pain tolerance of the patient and the extent of surgery. No one wants to send a patient home in pain,” she said.
William Love, DDS, is director of dental services at the University of California, Davis. He says all medical professionals need to consider the long-term consequences of their prescriptions.
“While we all want our patients to have a comfortable recovery, we must now be more aware that we are fixing a short-term problem (pain) and creating a potentially greater long-term problem (dependence). I would encourage prescribing dentists to familiarize themselves with the literature regarding alternative pain management strategies,” he told Healthline.
Many dentists have already adjusted their prescribing in the wake of the opioid epidemic.
Ray Stewart, DMD, is a professor and pediatric dentist at the University of California San Francisco School of Dentistry.
He says the only opiates he provides are for oral conscious sedation procedures and are all administered on site. He hasn’t written a prescription for opioids for pain control purposes for the past three years.
He argues that pressure from parents to prescribe opioids can have ulterior motives.
“I firmly believe that some parents use their children to obtain opiates that are not indicated or necessary, and use the prescription to satisfy their own addictions,” he told Healthline
Several of the experts who spoke with Healthline said there is significant pressure from parents and patients to prescribe drugs that are perceived to be stronger and more effective.
“In a world with online reviews and the competitive nature of dentistry in the United States, dentists are often afraid of having an upset patient because of their post-operative pain. I think as a profession, we really need to think about realistic expectations. Is it OK to have pain after a dental extraction even if that means avoiding opioids? Or, is the expectation that one should have zero pain and we must rely on opioids? I personally believe the safer trade-off is avoiding opioids even if that means having some discomfort for a couple of days,” Love said.
“Many dentists may prescribe opioids as a ‘just in case you need it’ medication so that the patient doesn’t call after hours or over the weekend. The reality is that prescribing these dangerous medications is far too easy and is often done without thinking about the consequences,” he added.
Adolescents and teens prescribed opioids following dental procedures are at increased risk of persistent use and abuse of these drugs.
Parents and patients should consider non-opioid medications, which are just as effective for pain relief associated with wisdom teeth removal.