Photo Credit: Staras
During the 106th AAOMS Annual Meeting, Scientific Session and Exhibition, various sessions covered acute dental pain while lowering opioid use among these patients.
In a study that was not directly linked to AAOMS, researchers examined the use of opioids by dentists among patients experiencing acute pain.
The management of acute dental pain often involves various medical providers, such as dentists and emergency medicine professionals, who prescribe medication based on the severity of pain, from mild tooth extraction pain to severe conditions like symptomatic irreversible pulpitis. A recent study comparing opioid prescribing trends between 2017-2018 and 2008-2009 revealed a significant reduction in the morphine milligram equivalents (MME) prescribed by dentists (41.3% decrease) and emergency physicians (70.5% decrease). However, physician assistants and nurse practitioners showed a 22.7% increase in MME prescriptions. Dentists had the lowest average MME prescriptions, which declined from 1.02% in 2008-2009 to 0.83% in 2017-2018.
Access to dental care in the United States presents challenges, leading many patients to seek treatment in emergency departments (EDs), where acute dental pain is often managed temporarily with analgesics, including opioids. Around 37% of ED visits for dental symptoms result in opioid prescriptions, highlighting a tendency to rely on these medications in non-dental settings. This is despite evidence suggesting that nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective in targeting inflammation-related dental pain than opioids, which can lead to adverse outcomes like emergency visits and mental health issues when used for pain management.
The use of opioids for acute dental pain, especially in adolescents, poses risks of developing opioid use disorder. For example, adolescents undergoing third-molar extractions who receive opioid prescriptions have an increased risk of prolonged opioid use and substance use disorders. While alternatives such as NSAIDs and local anesthetics show more promise for effective pain management, providers continue to rely on opioids, influenced by varying guidelines and the lack of uniformity in clinical practice recommendations.
The National Academies’ 2020 report called for standardized, evidence-based guidelines to address the inconsistency in pain management practices. This led to the FDA funding the development of clinical practice guidelines (CPG) focused on managing acute dental pain. These guidelines emphasize the use of NSAIDs, alone or with acetaminophen, as the first-line treatment, reserving opioids only when other options are inadequate. The CPG also stresses the importance of shared decision-making between patients and providers, tailoring pain management strategies to individual needs while minimizing risks associated with opioid use.
Ultimately, while alternatives to opioid analgesics exist, the persistence of opioid use in dental pain management underscores the need for broader adoption of evidence-based guidelines and improved access to definitive dental care. Enhanced referral processes between emergency and dental services and the expansion of preventive oral health care can further reduce the reliance on opioids and improve outcomes for patients experiencing acute dental pain, according to the study.
