Opioid Prescribing Patterns Among Oral and Maxillofacial Surgeons: A Regional Survey-Based Study

Freilich, Elie; Zhao, Yihong; Yan, Shapei; Caldroney, S.; Mehra, Pushkar

doi:10.1016/j.joms.2020.02.032

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…The reliance on opioid analgesics for dental pain in the US is more likely a cultural phenomenon than a medical necessity. The superiority of non-opioid analgesics such as APAP/ibuprofen combinations to opioids for dental pain has been common knowledge for many years 17,18,22 , yet dentists continue to rely on opioids in North America 10,20,21 . In countries where dentists have limited access to opioid drugs, very few opioids were prescribed for dental pain 40,41 .…”

Section: Discussionmentioning

confidence: 99%

“…Prescriptions for pain management after surgical tooth extractions illustrate the current problem: opioid prescription decreased only moderately from 90% in 2011 to about 70% in 2020 in dental clinics affiliated to US dental schools 7,15 , though considerable evidence demonstrates that non-opioid analgesics, such as NSAIDs or a combination of NSAIDs such as ibuprofen with acetaminophen (N-acetyl-para-aminophenol, or APAP), are superior to opioids for dental pain after dental extractions, including third molar surgeries [16][17][18] . Possible explanations include: 1) immediate-release opioids continue to be the drugs of choice in patients who cannot tolerate NSAIDs or APAP due to direct side effects or indirect effects from interaction with other medications 19 , 2) cases in which NSAIDs are ineffective, 3) dental prescribers are not convinced that short-term opioid prescription may result in opioid dependency 20 , and 4) ingrained prescription habit 21 .…”

Section: Introductionmentioning

confidence: 99%

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Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Huang

Rasubala

Gracely

et al. 2022

Preprint

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ObjectiveTo evaluate long-term changes in pain management strategies and assess the outcomes of opioids and non-opioid combination analgesics after dental extractions.MethodsThis is a cross-sectional study of patients who received dental extractions and analgesic prescriptions in a large dental urgent care center in two 12-month periods: January 2012 to December 2012 (Year-2012) and March 2021 to February 2022 (Year-2022). Data extracted from electronic records include type of dental extractions, analgesics prescribed, and follow-up visits. The primary outcome was failure rate measured by the proportions of patients who returned to the clinic for management of pain after receiving dental extractions and analgesic prescriptions.ResultsA total of 3,357 patients in Year-2012 and 3,785 patients in Year-2022 received analgesic prescriptions in conjunction with dental extractions. Combination analgesics were significantly higher in Year-2022 (62.5%) than in Year-2012 (34.9%) (RR=1.79, 95% CI 1.70-1.89. p<0.0001). Combinations analgesics were almost exclusively opioids and 1,166 patients, or 34.7%, received opioids in Year-2012, compared to none received opioids, 49.4% received ibuprofen/ acetaminophen and 13.1% received gabapentin combinations in Year-2022. After surgical extractions, a majority were prescribed opioids (52.4%), followed by ibuprofen (46.2%) in Year-2012. In contrast, a majority received ibuprofen/acetaminophen (56.2%) or gabapentin combinations (17.3%) in Year-2022. Ibuprofen/acetaminophen had a failure rate (2.2%) lower than gabapentin combinations (4.4%) (RR=0.50, 95%CI 0.31-0.83. p=0.01), or opioid combinations (21.4%) (RR=0.10, 95%CI 0.08-0.14. p<0.0001). Failure rate for gabapentin combinations was lower than opioids (RR=0.21, 95%CI 0.14-0.31. p<0.0001).Conclusions and RelevanceThis study showed a paradigm shift from opioids and single medication analgesics to non-opioids and combination analgesics with ibuprofen, acetaminophen and gabapentin as components in prescribing for pain after dental extractions, which presents an opportunity to minimize or eliminate our reliance on opioids for dental pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Huang

Rasubala

Gracely

et al. 2022

Preprint

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“…In a recent national survey of 822 dentists' opioid prescribing, only 7% of respondents indicated they practiced in an academic setting [6]. Another survey of 151 oral and maxillofacial surgeons in New England reported that those working primarily in academic settings prescribed fewer opioids and were more likely to be in the lowest quartile of opioid prescribers by quantity (75% of academic dentists in the lowest quartile vs. 20.5% of non‐academic dentists) [7]. Based on self‐report, it would appear the overall contribution is low.…”

Section: Introductionmentioning

confidence: 99%

Dental opioid prescription patterns in academic and community settings

Oyler

Rojas-Ramirez

Nakamura

et al. 2023

J Public Health Dent

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Objectives: Reports of interventions to improve dental opioid prescribing have come primarily from academic settings, but most opioid prescriptions are written by community dentists. This analysis compares prescription characteristics between these two groups to inform interventions to improve dental opioid prescribing in community settings. Methods: State prescription drug monitoring program data from 2013 to 2020 were used to compare opioid prescriptions from dentists at academic institutions (PDAI) to prescriptions from dentists in non-academic settings (PDNS). Linear regression was used to assess daily morphine milligram equivalents (MME), total MME, and days' supply, adjusting for year, age, sex, and rurality. Results: Prescriptions from dentists at the academic institution accounted for less than 2% of over 2.3 million dental opioid prescriptions analyzed. Over 80% of prescriptions in both groups were written for <50 MME per day and for ≤3 days' supply. On average, in the adjusted models, prescriptions from the academic institution were written for about 75 additional MME per prescription and nearly a full day longer duration. Compared to adults, adolescents were the only age group who received both higher daily doses and longer days' supply. Conclusions: Prescriptions from dentists at academic institutions accounted for small percentage of opioid prescriptions, but prescription characteristics were clinically comparable between groups. Interventional targets to reduce opioid prescribing in academic institutions could be applied to community settings.

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“…3 Another group analysed data from 118 New England OMFS for several officebased surgical procedures and respondents indicated they typically prescribed 8-12 opioid tablets, suggesting fewer tablets were prescribed in academic than in private settings. 4 Tufts University School of Dental Medicine have sponsored CE activities for many years, recently publishing a Dental Clinics of North America issue on opioid…”

mentioning

confidence: 99%

1930s techniques

Williams

2021

Br Dent J

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Sir, we have reviewed the paper on opioids use in the UK and US by Tayara and Ahmed (BDJ 2021; 230: 159-164) and wish to offer the following comments. The cohorts from the three dental schools were small and dissimilar and the results difficult to interpret. No acknowledgement is made of how the cohorts were identified to avoid selection bias and whether the institutions involved approved the survey. No mention is made of the number of opioid pills prescribed, nor of the adjunctive strategies that might have been used in addition for pain control.Our chief concern is that the authors have made little attempt to view their results in any type of context. They do not account for the dramatic differences between their study (two-fold difference) and the JAMA report (37-fold difference). 1 In 2016, the Governor of Massachusetts initiated a Working Group to curb the opioid crisis by involving State officials, faculty from the three Boston Dental Schools and a student group. 2 Massachusetts General Hospital OMFS Department reduced their average prescription for third molar extractions from 20 to eight pills per patient without decrease in patient satisfaction or increases in post-operative visits or telephone calls. 3 Another group analysed data from 118 New England OMFS for several officebased surgical procedures and respondents indicated they typically prescribed 8-12 opioid tablets, suggesting fewer tablets were prescribed in academic than in private settings. 4 Tufts University School of Dental Medicine have sponsored CE activities for many years, recently publishing a Dental Clinics of North America issue on opioid

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Opioid Prescribing Patterns Among Oral and Maxillofacial Surgeons: A Regional Survey-Based Study

Cited by 7 publications

References 8 publications

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Pain management after dental extractions – non-opioid combination analgesics minimize opioid use for acute dental pain

Dental opioid prescription patterns in academic and community settings

1930s techniques

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