Is it time US dentistry ended its opioid dependence?

Background.

In 2017, 11.4 million US citizens misused prescription opioids, resulting in 46 overdose-deaths daily and a $78.5 billion burden on the economy. Dentists are one of the most frequent prescribers of opioids and there is concern that dental prescribing is contributing to the opioid crisis.

Methods.

A recent study showed 22.3% of US dental prescriptions were for opioids compared to 0.6% in England, where nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen accounted for most analgesic prescriptions. This observation prompted a review of international analgesic prescribing habits and of the advantages and disadvantages of opioids and NSAIDs for treating dental pain.

Results.

US opioid prescribing far exceeded that in other countries where NSAIDs accounted for the vast majority of dental analgesic prescribing. Furthermore, recent reviews confirm NSAIDs, and NSAID-acetaminophen combinations are as or more effective than opioids for controlling dental pain and cause significantly fewer side-effects.

Conclusions.

In light of the potential for misuse, and evidence that NSAIDs are as effective as opioids and have fewer side effects, there is clear patient benefit in avoiding opioids for the prevention or management of dental pain.

Practical Implications.

A growing preponderance of evidence shows that opioids are not needed for routine dental care. This article provides an overview of the evidence and outlines possible pain management models to minimize opioid use in dentistry. The purpose is to stimulate debate on this important topic and encourage the development of definitive guidance by professional bodies, health providers, and state and federal agencies.