Dentists Continuing Use of Opioid Analgesics for Acute Pain Management

Objectives: Each year thousands die from opioid overdose. Dentists are one of the top prescribers of opioid containing analgesics to opioid naïve patients. Reducing unnecessary opioid analgesic prescriptions may decrease opioid related addiction and deaths. This study examines current dentist prescribing habits.
Methods: E-mail addresses for all active New Jersey dentists were obtained from Department of Consumer Affairs web-site. After IRB approval, a Qualtrics e-mail survey was administered asking dentists about procedures for which they normally prescribe opioid containing analgesics, their use of non-opioid analgesics, and reasons why they don’t consider combination non-opioid analgesics (acetaminophen/ibuprofen). Three reminders were sent to non-respondents. Descriptive and comparative (Chi-square/Fisher’s Exact Test) statistics were calculated using IBM-SPSS Statistics 25. Logistic regressions were also performed to examine effect of demographic variables.
Results: Of 4940 successfully sent e-mails, 592 dentists responded for 12.0% response rate. Dentists report normally prescribing opioid containing analgesics for impacted 3^rd molar extraction (52.3%), implant placement surgery (23.3%), periodontal osseous surgery (22.7%), endodontic surgery (19.6%) and patients presenting with an emergency (15.6%). 53% of dentist who do not prescribe combined acetaminophen/ibuprofen have “just never tried it”, 13.6% did not know the combination could be taken and 15.9% do not think there is sufficient evidence showing the combination works or is more effective. Chi-Square/Fisher’s Exact Test (P<0.05) and logistical regression identified several dentist characteristics (graduation year categories, faculty or hospital appointment, gender) associated with different prescribing habits.
Conclusions: Dentists are still routinely prescribing opioid containing analgesics to control acute emergency and post-operative pain. As there are limited pragmatic clinical trials showing the comparative effectiveness of opioid vs. non-opioid, containing analgesics, clinical trials need to be conducted. Results need to better inform dentists when non-opioid containing analgesics, including combination non-opioid containing analgesics, are at least as good, if not better than opioid containing analgesics.