Dental patients taking opioids experience more pain after procedures, surprising study finds

ANN ARBOR, Mich. — The use of opioids in the United States is a loaded topic, and its implications go far beyond pain management. It feels like countless lives have been ruined or shortened because of opioid use and addiction, but these prescriptions are still handed out in large quantity all over the United States. Why? Well, they help numb the pain. Surprisingly, though, a new study conducted at the University of Michigan is challenging even this notion.

The research team found that dental patients who had been prescribed opioids after a tooth extraction actually reported feeling more pain than another group of patients who weren’t given opioids. Additionally, reported patient satisfaction with their pain management wasn’t changed at all by the prescription of opioids.

In all, 325 patients who had teeth pulled were asked to rate their daily pain levels and satisfaction six months following the procedure. About half of that group were prescribed opioids while the others were not.

“I feel like the most important finding is that patient satisfaction with pain management was no different between the opioid group and non-opioid group, and it didn’t make a difference whether it was surgical or routine extraction,” says study co-author Romesh Nalliah, clinical professor and associate dean for patient services at Michigan’s School of Dentistry, in a release.

Another finding of note was the observation that many patients who were prescribed opioids, about half, didn’t even finish their prescriptions. This could potentially put their loved ones at risk of developing an opioid addiction themselves by having these substances present in the home.

“The real-world data from this study reinforces the previously published randomized-controlled trials showing opioids are no better than acetaminophen and nonsteroidal anti-inflammatory drugs for pain after dental extraction,” comments study co-author Chad Brummett, director of the Division of Pain Research and of Clinical Research in the Department of Anesthesiology at Michigan Medicine, UM’s academic medical center.

“These data support the Michigan OPEN prescribing recommendations calling for no opioids for the majority of patients after dental extractions, including wisdom teeth extraction,” Brummet adds.

These results could prove transformative for the dental industry, and may result in a reexamination of prescribing practices following dental procedures. Right now, The American Dental Association recommends that no more than seven days’ worth of opioids be prescribed following dental operations, but even that may be too much.

“I think we can almost eliminate opioid prescribing from dental practice. Of course, there are going to be some exceptions, like patients who can’t tolerate nonsteroidal anti-inflammatories,” Nalliah says. “I would estimate we can reduce opioid prescribing to about 10% of what we currently prescribe as a profession.”

For individual dentists, researchers say these findings suggest that they should feel free to avoid prescribing opioids. Alternative pain management options like nonsteroidal anti-inflammatory drugs or acetaminophen appear to result in the same level of patient satisfaction and actually control pain more efficiently. So, dentists shouldn’t feel obligated to prescribe opioids just to keep their patients happy.

As far as why opioids aren’t doing the job against pain anymore, Nalliah has two theories. The first is that dentists are only prescribing opioids for the toughest dental cases, which means those patients are probably in more pain in the first place.

“Or alternatively, and this is the reason I tend to accept, is that our study concurs with previous studies that suggest opioids are not the most effective analgesic for acute dental pain,” Nalliah explains.

“Dentists are torn between wanting to satisfy patients and grow business and limiting their opioid prescribing in light of the current crisis. 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,” she concludes.

The study is published in JAMA Network Open.