Neha Bhardwaj, PharmD Candidate

The opioid epidemic continues to cause a nationwide crists that health care professionals often struggle to manage due to the increase in prescription opioid use over recent years.

Although many factors contribute to this epidemic, 1 factor worth noting is the contribution from providers within the field of dental procedures and oral surgery, particularly among higher risk populations. Dentists prescribe 1 in 10 opioids within the United States, contributing to a large volume of opioid prescriptions.

Current American Dental Association (ADA) guidelines for use of opioids in the treatment of dental pain recommend nonsteroidal anti-inflammatory (NSAID) analgesics as the first-line therapy regarding acute pain management. The ADA also recommends opioid therapy only after other options have been exhausted, and says prescribers should use prescription drug monitoring programs and assess the overall risk of the patient.

 However, research indicates that dental opioid prescribing rates do not adhere to these guidelines and suggests that changes must be made to the current system of prescribing.

In a recent study analyzing US commercial dental visits between 2011 and 2015, 29.3% of dental visits included opioid prescriptions that exceeded the recommended amount of less than 80 morphine milligram equivalents.

 Additionally, 28.4% percent of visits involving these prescriptions were patients between the ages of 18 and 34, and 53% of visits within this cohort were for oral and maxillofacial surgery appointments.

These data are concerning since evidence supports that young adults are at a higher risk of developing opioid dependencies.

 In fact, in a 2019 study of patients ages 16 to 25 whose first opioid encounter was through a dental-related prescription, 5.8% of patients in an opioid-exposed cohort experienced at least 1 diagnosis of opioid abuse, compared with only 0.4% in the opioid non-exposed control group.

These alarming statistics suggest that dental clinicians must be more adequately educated on proper opioid prescribing practices. Many state dental boards require providers to complete between 2 and 4 hours of continuing education (CE) training, or at least 3 CE modules per biennium about prescription opioid abuse and safe prescribing practices.

However, these minimum requirements may not be sufficient to combat the growing problem the United States faces. 

One potential solution to dental overprescribing could be targeting the initial education on prescribing practices within dental schools. Pharmacists specializing in pain management could collaborate on lectures and educational material in order to ensure that the true impact of overprescribing is recognized and to establish why NSAIDs, which are safer options, may work more effectively for post-operative pain management. Implementing further education on substance use disorders would also be useful, especially for surgeons who may perform wisdom teeth extractions on high-risk populations.

Another crucial part of this education could include interprofessional activities with both pharmacy and dental students. This would encourage dental students to recognize pharmacists as a resource for questions regarding pain management and would remind pharmacy students to further examine dental opioid prescribing habits.

Pharmacy students could help educate dental students about identifying patients at risk for substance use disorders and drug seeking behavior using prescription drug monitoring programs. Pharmacy students can also help dental students in conducting more thorough patient interviews to verify that patients are not already on existing opioid prescriptions or other interacting medications. Interprofessional education could open doors for further interaction between the 2 fields, including a possible role for pharmacists in dental clinics to improve overall outcomes for dental patients. 

Through the supply of pain management resources and interprofessional education, pharmacists can play an active role in decreasing the contributions of dental practitioners to the growing opioid epidemic and improving patient outcomes nationwide. 

1. Suda JK, Zhou J, Rowan AS, Charlesnika TE, Gellad FW, Calip SG. Overprescribing of Opioids to Adults by Dentists in the U.S., 2011-2015. AM J Prev Med. 2020 Apr 01;58(4):473-86.

2. Dowell D, Haegerich MT, Chou R.  Centers for Disease Control & Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. 2016 Mar 18:65(1);1-49.

3. Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse. JAMA Intern Med. 2019;179(2):145—152. 

4. American Dental Association: State CE Statutes and Regulations; Dentist Continuing Education [Internet].  American Dental Association. [cited 2020 July  29]. Available from 

https://www.ada.org/en/education-careers/continuing-education

Neha Bhardwaj, PharmD Candidate

Articles