Opioid usage: patients prescribed such drugs after tooth extraction reported worse pain
Opioid usage to soothe the pain of a pulled tooth could be drastically reduced or eliminated altogether from dentistry, say University of Michigan researchers.
More than 325 dental patients who had teeth pulled were asked to rate their pain and satisfaction within six months of extraction. Roughly half of the study’s patients who had surgical extraction and 39% who had routine extraction were prescribed opioids.
Recommended course: Pain Management: Evidence-Based Guidance for Prescribing Opioids
The U-M researchers compared the pain and satisfaction of those who used opioids to those who didn’t.
“Patient satisfaction with pain management was no different between the opioid group and non-opioid group. It didn’t make a difference whether it was surgical or routine extraction,” said study co-author Romesh Nalliah, clinical professor and associate dean for patient services at the U-M School of Dentistry.
Study results
Surprisingly, patients in the opioid group actually reported worse pain than the non-opioid group for both types of extractions, Nalliah said.
The researchers also found that roughly half of the opioids prescribed remained unused in both surgical and nonsurgical extractions. This could put patients or their loved ones at risk of future misuse of opioids if leftover pills are not disposed of properly.
“The real-world data from this study reinforces the previously published randomized-controlled trials. These show that opioids are no better than acetaminophen and nonsteroidal anti-inflammatory drugs for pain after dental extraction,” said study co-author Chad Brummett, director of the Division of Pain Research and of Clinical Research in the Department of Anesthesiology at Michigan Medicine, U-M’s academic medical center.
Guidelines for opioid use after surgery
Brummett co-directs the Michigan Opioid Prescribing Engagement Network, or Michigan OPEN. It has shared guidelines for the use of opioids in patients with acute pain from surgery and medical procedures.
“These data support the Michigan OPEN prescribing recommendations. These call for no opioids for the majority of patients after dental extractions, including wisdom teeth extraction,” he said.
The results have big implications for both patients and dentists. It suggests prescribing practices need an overhaul, Brummett and Nalliah said.
The American Dental Association suggests limiting opioid prescribing to seven days’ supply, but Nalliah believes that’s too high.
“I think we can almost eliminate opioid prescribing from dental practice. Of course, there are going to be some exceptions, like patients who can’t tolerate nonsteroidal anti-inflammatories,” he said. “I would estimate we can reduce opioid prescribing to about 10% of what we currently prescribe as a profession.“
