With the opioid crisis being blamed for falling life expectancy in many American demographics, the last thing we need is to be prescribing them in cases where alternatives work just as well. This may be the case for most dental prescriptions, with potentially disastrous, but easily prevented, results.
Most people who become addicted to opioids first encountered them when they got a prescription for pain (although the proportion is falling). Only 6-6.5 percent of those prescriptions were for tooth pain, but dentists account for a much larger proportion of childhood opioid prescriptions. Consequently, many people's first encounters with opioids occur after a trip to the dentist, potentially making them more likely to use, and abuse, the drugs later on. Moreover, since it is common not to finish an opioid prescription for temporary pain, the leftover drugs become a hazard if not disposed of correctly.
Professor Romesh Nalliah of the University of Michigan set out to investigate the question of how many of these prescriptions are actually necessary. No one is suggesting people should return to the 19th Century and suffer dental work without painkillers at all – but non-addictive alternatives exist.
In Jama Network Open, Nalliah and Brummett report on interviews of 325 patients about the pain they experienced during tooth extractions. Around half of those who had surgical extractions were prescribed opioids, as were 39 percent of those with routine extractions. The rest were given non-addictive painkillers such as parcetamol or ibuprofen.
Those given the opioids actually described having experienced more pain than those on the alternatives. Nalliah acknowledges dentists may have prescribed opioids in cases where there was reason to think the pain was likely to be particularly bad, but thinks the dominant reason is that opioids are simply not more effective painkillers for dental pain. He notes this theory is supported by randomized controlled trials, as well as the fact there was only a small difference in prescriptions between surgical and routine extractions.
"Dentists are torn between wanting to satisfy patients and grow business and limiting their opioid prescribing in light of the current crisis,” Nalliah said in a statement. “I think it's an extremely liberating finding for dentists who can worry more about the most effective pain relief rather than overprescribing for opioids."
Nalliah acknowledges opioids may be needed by people with allergies to alternatives or in exceptional cases but thinks 90 percent of dental use can be eliminated, potentially sparing a lot of damage.
The obvious question is how applicable these results are to the other 94 percent of opioid prescriptions. “I don't believe our findings can be extrapolated to fields outside dentistry,” Nalliah said. “But it does show researchers places to start their investigations.”
