Association of Opioid Use With Pain and Satisfaction After Dental Extraction

Abstract

IMPORTANCE Dentists commonly prescribe opioids to relieve pain after tooth extraction.Understanding the differences in patient-reported outcomes between opioid users and nonusers could encourage the adoption of more conservative and appropriate prescribing practices in dental medicine.OBJECTIVE To evaluate whether pain and satisfaction scores reported by patients who used opioids after tooth extraction were similar to the levels reported by patients with no opioid use. DESIGN, SETTING, AND PARTICIPANTSThis quality improvement study was conducted in the 14 dental clinics of the University of Michigan School of Dentistry. Eligible adult patients of these clinics who underwent routine or surgical extractions between June 1, 2017, and December 31, 2017, were contacted by telephone within 6 months of the procedure. Patients were surveyed about the type of extraction, use of prescription opioid (if given), use of nonopioid analgesics, pain levels, and satisfaction with care after the procedure. Data analysis was conducted from February 1, 2018, to July 31, 2018. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported pain as assessed by the question, "Thinking back, how would you rate your pain in the first week after your dental procedure?" with a 4-point pain scale of no pain, minimal pain, moderate pain, or severe pain. Secondary outcomes included self-reported satisfaction with care as assessed by a Likert scale ranging from 1 to 10, in which 1 was extremely dissatisfied and 10 was extremely satisfied. RESULTS The final cohort comprised 329 patients, of whom 155 (47.1%) underwent surgical extraction (mean [SD] age, 41.8 [18.1] years; 80 [51.6%] were men) and 174 (52.9%) underwent routine extraction (mean [SD] age, 52.4 [17.9] years; 79 [45.4%] were men). Eighty patients (51.6%) with surgical extraction and 68 (39.1%) with routine extraction used opioids after their procedure. In both extraction groups, patients who used opioids reported higher levels of pain compared with those who did not use opioids (surgical extraction group: 51 [64.6%] vs 34 [45.3%], P < .001; routine extraction group: 44 [64.8%] vs 35 [33.1%], P < .001). No statistically significant difference in satisfaction was found between groups after surgical extraction (median [interquartile range] scores: 9 [7-10] for nonopioid group vs 9 [8-10] for opioid group) and routine extraction (median [interquartile range] scores: 10 [8-10] for nonopioid group vs 9 [7-10] for opioid group).CONCLUSIONS AND RELEVANCE This study found that patients who used opioids after tooth extraction reported significantly higher levels of pain compared with nonusers, but no difference in satisfaction was observed.

Knowledge, Awareness and Practice of Opioid Analgesics in Dental Management Among Undergraduates- A Questionnaire Based Study

“…The probability of being prescribed hydrocodone was highest among uninsured patients (68.7%) and for oxycodone, it was highest among private insurance patients (33.6%) and the results were statistically not significant (Okunseri et al, 2015). A study conducted by nalliah et al on the association of opioid analgesics on pain and satisfaction after a dental extraction shows that patients who used opioids after tooth extraction reported significantly higher levels of pain compared with nonusers, but no difference in satisfaction was observed (Nalliah et al, 2020). It is recommended that after a dental procedure, patients should be prescribed a mild dose of analgesic after a dental treatment and if the pain does not subside, analgesics in combination with acetaminophen is recommended and still on inadequate relief of pain leading to moderate to severe pain, an opioid analgesic can be prescribed in mild dose in combination with acetaminophen.…”

Satisfação dos pacientes com o atendimento odontológico

“…Quanto ao ano de publicação, os anos de 2019 6,8,11,16,21-27 e 2018 [28][29][30][31][32][33][34][35][36][37][38] tiveram o maior número de artigos, onze em cada ano; seguidos de 2015 com sete artigos publicados 14,[39][40][41][42][43][44] , 2020 com cinco [45][46][47][48][49] , 2017 com quatro 1-52 , 2010 [53][54][55] , 2012 [56][57][58] , 2014 2,59,60 e 2016 15,61,62 com três artigos cada; 2005 63,64 , 2011 65,66 e 2013 7,67 com dois artigos cada ano, e 2008 12 com apenas um artigo publicado.…”

Receipt of opioids and patient care experiences among nonsurgical hospitalized adults

“…For instance, some of the studies found that higher HCAHPS scores (ie, better patient experiences) were associated with less, not more, opioid use 18,19 . Other studies reported a lack of association between receipt of opioids and surgical patients’ experiences with care 15,17,20 . Second, prior studies focused on surgical inpatients failed to account for potential bias resulting from confounding by indication, which is the possibility that individuals receiving opioids differ meaningfully from patients who do not.…”

“…Third, reviews of the literature found no published study showing that providers obtain higher HCAHPS scores by providing inappropriate care, such as overprescribing opioids to hospitalized inpatients 21,22 . Finally, prior studies 17,17‐21 have not examined the association between receipt of opioids and patient care experiences among nonsurgical inpatients, who account for almost half of all US hospitalizations 23 . Importantly, unlike for surgical inpatients, clinical practice guidelines offer little guidance on how to prescribe opioids for nonsurgical inpatients.…”