By Pat Anson, PNN Editor

Over half of the opioid prescriptions written by dentists in the United States exceed the 3-day supply recommended by pain management guidelines, according to a large new study that also found a stronger dose than necessary was prescribed nearly a third of the time.

The findings, published in the American Journal of Preventive Medicine, are important because dentists are responsible for about 10% of the opioids prescribed in the U.S.

“Dental procedures like extractions can leave patients with a lot of pain that needs to be managed, and many dentists are doing a wonderful job of managing their patients’ pain appropriately and responsibly,” said Jessina McGregor, a researcher in the Oregon State University College of Pharmacy. “But our findings suggest that there’s room for improvement among some dentists, improvement that could make a huge difference in our society as we try to combat the opioid crisis.”

McGregor and her colleagues reviewed insurance records from over half a million dental visits from 2011 to 2015. The study period was before the CDC released its controversial opioid guideline in 2016, so the findings may not reflect current practices in dental pain management.

Nevertheless, the study is the largest to date of dental visits in the U.S. that resulted in an opioid prescription.

Fifty-three percent of the time, patients were given more than the 3-day supply of opioids recommended by the CDC for most types of acute, short-term pain. Some dental associations recommend no more than two days’ supply – even for dental procedures associated with the severe pain.

In addition to the excess number of pills, researchers say the dose of opioids prescribed by dentists was stronger than what was medically necessary 29% of the time.

Men, young adults aged 18-34, and people living in the South were most likely to be prescribed opioids that were stronger than needed.

“One large potential area for improvement is the almost 30% percent of opioids that were prescribed following procedures where the pain intensity was expected to be mild and manageable by non-opioid analgesics like ibuprofen or acetaminophen,” said McGregor.

“Our statistical models suggest that even something as simple and straightforward as substituting a lower-potency opioid like hydrocodone for oxycodone could make an enormous reduction in overprescribing, as much as a 20% reduction.”

Researchers say prescribing guidelines tailored to dentists and oral pain are urgently needed to reduce excess prescribing . A small 2016 study of patients who had their wisdom teeth removed found that over half the opioids prescribed went unused. That suggests as many as 100 million excess pain pills are prescribed annually by dentists.

Anti-opioid activists have long claimed that young people can easily became addicted to opioids after dental surgery. But a large 2018 study found that the risk of long-term opioid use after wisdom tooth removal is relatively rare. The study of over 70,000 teens and young adults found that only 1.3% were still being prescribed opioids months after their initial prescription.