Opioids for Pain After Tooth Pulled May Not Be Needed

A new study finds that the use of opioids to soothe the pain of a pulled tooth could be drastically reduced or eliminated altogether.

For the study, researchers at the University of Michigan asked more than 325 dental patients who had teeth pulled to rate their pain and satisfaction within six months of extraction. Roughly half of the study’s patients who had surgical extraction and 39 percent who had routine extraction were prescribed opioids, according to the researchers.

Surprisingly, patients in the opioid group actually reported worse pain than the non-opioid group for both types of extractions, the study discovered.

“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,” said study co-author Dr. Romesh Nalliah, a clinical professor and associate dean for patient services at the U-M School of Dentistry.

The researchers also found that roughly half of the opioids prescribed remained unused in both surgical and nonsurgical extractions. This could put patients or their loved ones at risk of future misuse of opioids if leftover pills are not disposed of properly, the researchers claimed.

“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,” said study co-author Dr. Chad Brummett, director of the Division of Pain Research and of Clinical Research in the Department of Anesthesiology at Michigan Medicine, the university’s academic medical center.

Brummett also co-directs the Michigan Opioid Prescribing Engagement Network, or Michigan OPEN, which has developed, tested, and shared guidelines for the use of opioids in patients with acute pain from surgery and medical procedures.

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

The results have big implications for both patients and dentists, and suggest prescribing practices need to change, according to the researchers.

The American Dental Association suggests limiting opioid prescribing to a seven=day supply, but Nalliah believes that’s too high.

“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,” he said. “I would estimate we can reduce opioid prescribing to about 10 percent of what we currently prescribe as a profession.”

For dentists, many of whom are sole proprietors, this new information means they needn’t worry so much about unhappy patients changing practices if they aren’t prescribed strong opioids. Alternatives such as nonsteroidal anti-inflammatory drugs or acetaminophen appear to control pain better, and patient satisfaction remains high.

Nalliah gives two possible reasons for this. First, dentists may have prescribed opioids in only the toughest cases, which would have resulted in more pain regardless.

“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,” he said.

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

Dentists account for about 6 percent to 6.5 percent of U.S. opioid prescriptions, a relatively small amount. But the study notes that dentists are among the most common prescribers for minors, and for many patients, dental opioid prescriptions are their first exposure, the researchers said.

The study was published in JAMA Network Open.

Source: University of Michigan

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