August 16, 2017

Opioid Epidemic: What Dentists and Oral Surgeons are Doing

America’s opioid epidemic has killed more than 180,000 since 2000. Unfortunately, many of the victims became addicted after doctors prescribed them drugs like Oxycontin and Percocet. These prescriptions, however, were likely not their first exposure to powerful painkillers.

opioids - Doctor holding prescription pad

When health pros prescribe opioids for high school students, they are one-third more likely to abuse the drugs in the future.

According to the New York Times, most opioid prescriptions for people ages ten to nineteen are written by dentists and oral surgeons. This is largely due to the tradition of prescribing opioids after wisdom tooth removal.  This procedure is performed on millions of patients under the age of 25 every year. Almost every patient who undergoes this procedure is prescribed opioids.

When health pros prescribe opioids for high school students, they are one-third more likely to abuse the drugs in the future.

Learn more: Back to School Dental Care Checklist

“They don’t develop their addiction from that experience,” says psychiatrist and addiction specialist Dr. Andrew Kolodny. “But because of it, they’re no longer afraid of the drug and they like the effect. They’re getting their first taste of the drug from a doctor or dentist, and that increases the likelihood they would use it recreationally.”

Reducing Opioid Addiction

The first step towards reducing opioid addiction is prescribing “more cautiously,” according to Dr. Kolodny. Increasingly, oral health professionals are heeding this advice.

Leading this initiative is Dr. Harold Tu, director of the division of oral and maxillofacial surgery at the University of Minnesota School of Dentistry. Last year, he successfully lobbied the school to implement a new, mandatory protocol that teaches students to avoid opioids for their clinical patients.

The first-line treatment now consists of non-steroidal, anti-inflammatory drugs. These include ibuprofen (or NSAIDs) and acetaminophen. Tu’s students only prescribe opioids if the patient is allergic to one of these or needs stronger pain relief.

So far, Tu told the Times, “we have not seen an increase in patient complaints or patients returning saying ‘the NSAIDs are not working; I need something stronger’.”

Relief Equal To or Better Than Opioids

The notion that ibuprofen combined with acetaminophen could ever treat pain as effectively as opioids might seem a bit farfetched. However, a 2013 study found that the former treatment provides equal or better relief than the latter.*

Minneapolis oral surgeon Dr. Angie Rake used to give young patients “10 to 15 Vicodin” only to hear her parents’ ask for more. She has since reduced her opioid prescriptions by about 60%.  She now makes an effort to speak to parents about addiction.  “Now I have parents thanking me for taking time to educate them,” Dr. Rake said. “And a lot of times they say, ‘We’re really going to try to avoid these.’ ”

Now I have parents thanking me for taking time to educate them. And a lot of times they say, ‘We’re really going to try to avoid these.’

Dr. Rake is a firm follower of Dr. Tu along with Dr. Douglas Fain, president of the American Association of Oral and Maxillofacial Surgeons. He recently conducted a survey that found that half of his members have reduced opioid prescriptions. They now prescribe just three to four days’ worth of the drugs.

In addition to the number of prescriptions written, Dr. Fain has reduced dosage levels at his practice. “They’re here if you need them,” he says, but only for those in unbearable pain.

Read next: Ways to Avoid a Painful Visit to the Dentist

*Article Citation: JADA, Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions, August 2013Volume 144, Issue 8, Pages 898–908.

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