IADR Abstract Archives
Dental Treatment Delay Increases Exposure to Opioid Prescriptions
Objectives: Studies show approximately one third of opioids prescribed by dentists occur at non-surgical visits, raising questions about appropriateness of care. As well, research shows Medicaid adults have poor access to care and limited dental benefits in most states, along with overall higher opioid prescription rates. We examined the opioid prescribing patterns of dentists and the relationship between initial prescription, time until and type of next dental visit, and total opioid exposure (Morphine Milligram Equivalent; MME).
Methods: We used Medicaid administrative data, including enrollment, medical, pharmacy, and dental claims for adults (>18 years) from 2014-2016. Excluded enrollees were dual-eligible patients, had <90 days continuous eligibility, had a diagnosis of cancer, end-stage renal disease, or were in hospice care. Opioid prescriptions were matched by provider (dentist/medical) within a 14-day window (±7 days) of an index non-surgical dental visit. We used descriptive statistics to examine prescription patterns; clustered linear and multivariate linear regression analysis with random effects to examine the relationship between total MME exposure and time to next dental visit, categorized as surgical/non-surgical up to 90 days post index visits using CDT codes.
Results: Oregon Medicaid patients had 183,435 dental visits associated with an opioid prescription, of which 62,632 (34%) were non-surgical. Among these, within 90-days, 37% were followed by a non-surgical dental visit (mean: 23.5 days±21.4(SD)), 35% by a surgical dental visit (mean: 18.2 days±18.4(SD)), and 306 patients presented at the Emergency Department for a dental condition. Every one week increase until the next dental visit resulted in significantly (p<0.001) higher opioid prescriptions (MMEs) by both dentists (5.5) and physicians (86.8), and with higher amounts by dentists (75.5) when the follow-up is surgical.
Conclusions: A large number of non-surgical dental visits are associated with opioid Rxs. Delays to receiving definitive treatment is associated with increased overall exposure to opioid Rxs by dentists and physicians.
Methods: We used Medicaid administrative data, including enrollment, medical, pharmacy, and dental claims for adults (>18 years) from 2014-2016. Excluded enrollees were dual-eligible patients, had <90 days continuous eligibility, had a diagnosis of cancer, end-stage renal disease, or were in hospice care. Opioid prescriptions were matched by provider (dentist/medical) within a 14-day window (±7 days) of an index non-surgical dental visit. We used descriptive statistics to examine prescription patterns; clustered linear and multivariate linear regression analysis with random effects to examine the relationship between total MME exposure and time to next dental visit, categorized as surgical/non-surgical up to 90 days post index visits using CDT codes.
Results: Oregon Medicaid patients had 183,435 dental visits associated with an opioid prescription, of which 62,632 (34%) were non-surgical. Among these, within 90-days, 37% were followed by a non-surgical dental visit (mean: 23.5 days±21.4(SD)), 35% by a surgical dental visit (mean: 18.2 days±18.4(SD)), and 306 patients presented at the Emergency Department for a dental condition. Every one week increase until the next dental visit resulted in significantly (p<0.001) higher opioid prescriptions (MMEs) by both dentists (5.5) and physicians (86.8), and with higher amounts by dentists (75.5) when the follow-up is surgical.
Conclusions: A large number of non-surgical dental visits are associated with opioid Rxs. Delays to receiving definitive treatment is associated with increased overall exposure to opioid Rxs by dentists and physicians.