Study: Painkiller prescriptions for wisdom tooth surgery contributing to opioid crisis

ANN ARBOR, Mich. — Opioid prescriptions for a common dental procedure could be the beginning of drug abuse or addiction, according to a new University of Michigan study. Researchers say wisdom teeth extraction may cause more than just oral pain for a patient.

Does this mean that dental clinicians are inadvertently contributing to the opioid crisis?

Many, if not most, teens or young adults has one or more wisdom teeth removed in what has become something of a rite of passage. Most of the time, these individuals come out on the other side of the procedure with no lasting effects.

Except for one very disturbing trend: The opioid prescriptions casually handed out for pain management following wisdom tooth extraction can be the beginning of a spiral into an opioid addiction.

According to the study, teens and young adults between the ages of 13 and 30 who fill an opioid prescription for wisdom tooth removal are 2.7 times more likely to be filling prescriptions for opioids weeks or months later. Those between the ages of 19 and 30 are most at risk of developing an addiction.

“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need it for post-procedure pain,” says study lead Dr. Calista Harbaugh, a research fellow and surgical resident with the university, in a media release.

“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction,” she adds. “We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription.”

Study authors used insurance data to determine what happens when individuals who have not been exposed to opioids receive and fill their first opioid prescription. Researchers considered the outcome of the “opioid naive” — those who had not had an opioid prescription in the six months before wisdom tooth removal or a medical procedure requiring anesthesia in the year following wisdom tooth removal.

The data revealed that 1.3 percent of the 56,686 wisdom tooth patients who filled opioid prescriptions between 2009 and 2015 went on to become persistent opioid users, meaning these individuals filled another two or more prescriptions for opioids within the next year by any provider and for any reason.

Of the 14,256 wisdom tooth patients who did not fill a wisdom tooth related prescription, only 0.5 percent filled an opioid prescription within the next year.

Harbaugh says these numbers may not seem large, until we consider how many wisdom tooth extractions occur each year. The somewhat casual approach to pain management for this common procedure is putting many young people at risk, she cautions, even accounting for other possible factors for opioid use, such as mental health or chronic pain issues.

One of the turning points is filling that prescription in the first place. While researchers were able to establish the number of prescriptions filled, the data could not explain how many pills were actually used. Pills that are leftover are a temptation for potential misuse by the individual or even others who might have access to them.

“Patients must decide whether to fill the prescription and take the medication, and where to store and dispose of the unused pills. All of these decision points need to be discussed with patients,” says Harbaugh. “Patients should talk to their dentists about how to control pain without opioids first. If needed, opioids should only be used for breakthrough pain, as backup if the pain’s not controlled with other medications.”

The research team is now interviewing patients and their parents to find out how many opioid pills were taken for pain management following wisdom tooth extraction. They plan to use this information to create evidence-based prescribing guidelines. For now they suggest a shorter-length supply of opioids and only as a last resort.

“There are no prescribing recommendations specifically for wisdom tooth extraction,” says Harbaugh. “With evidence that nonsteroidal anti-inflammatories may be just as, if not more, effective, a seven-day opioid recommendation may still be too much.”

Findings were published in an August 7, 2018 JAMA research letter.

A similar study out of the Stanford University School of Medicine corroborated the findings of this research with a larger patient group of 754,002 16- to 25-year-olds in a national research database. Of this larger group, 12.9% (97,462 patients) received an opioid prescription, and of the group with opioid prescriptions, almost one-third (30.6%) of the 29,791 patients got those opioid prescriptions from a dental clinician.

Researchers concluded that there is a direct link to opioid first exposure and dental clinicians and advised that these prescriptions be limited because of the increased risk they pose for opioid use and abuse.

“Almost 7 percent of these patients had new, persistent use at least three months after the initial prescription and almost 6 percent had an opioid abuse diagnosis,” says the study’s lead author, Dr. Alan Schroeder, clinical professor of pediatrics at Stanford, in a release. “That’s pretty alarming.”

That study is published in the online edition of JAMA Internal Medicine.