Dental Opioid Crisis: Understanding the Problem and Practical Solutions
Author: Matt Hannan, DDS
Updated: August 15, 2023
Pain and dentistry, unfortunately, go hand in hand. As a dentist, I often see patients in pain and my first instinct is to help them get well as quickly as possible.
So for many years, I prescribed opioids to manage patients’ pain levels. But as the opioid crisis has grown, I’ve become increasingly aware of the risks associated with these drugs and the role dentists like myself play in this crisis.
This article will explore the link between dentistry and opioid addiction, the risks involved with opioid use, and alternative pain management strategies that can help curb the opioid epidemic from a dentist’s perspective. Lastly, we’ll highlight the UT Health San Antonio School of Dentistry $9.8 million grant from the National Institutes of Health (NIH) that aims to help curb opioid use.Recommended Reading: Dental Opioid Crisis | The Ultimate Guide
The link between dentistry and opioid addiction: What the research shows
The opioid epidemic is a significant public health crisis in the United States. According to the National Institute of Drug Abuse (NIH), over 68,000 people died from opioid overdoses in 2020 alone. In addition, over 16,000 people died from prescription opioid overdoses. Those statistics are alarming and heartbreaking.
Dentists play a significant role in this epidemic, as they are among the top prescribers of opioids. In a study published in the Journal of the American Dental Association, dentists wrote 6.4% of all opioid prescriptions in the United States in 2012.
The American Dental Association (ADA) reports that dentists wrote more than 12 million opioid prescriptions in 2016.
Opioid use and wisdom teeth extractions
Dental procedures, such as wisdom teeth extraction or oral surgery, can be excruciating, and dentists often prescribe opioids to help manage this pain. However, the long-term use of opioids can lead to addiction, overdose and death.
A study published in the Journal of the American Dental Association found that dental patients who received opioid prescriptions for wisdom teeth extractions were 3.6 times more likely to become long-term users of the drugs.
As a dentist, I realize how important it is to care for patients, especially those suffering from pain; however, the potential of long-term addiction is concerning.
For example, patients prescribed opioids for dental pain were likelier to continue using the drugs for non-dental pain and develop opioid use disorder.
NIH Grant for Opioid Reduction in Dentistry
The UT Health San Antonio School of Dentistry has recently been awarded a $9.8 million grant from the National Institutes of Health (NIH) that aims to help curb opioid use. This grant will be used to support research and education efforts to reduce the number of opioid prescriptions written by dentists and to improve pain management strategies.
The goal is to decrease the number of patients who become addicted to opioids and to improve overall patient outcomes. In addition to research, the grant will also be used to train dental students and practicing dentists on alternative pain management techniques and strategies for prescribing opioids more safely and responsibly.
This grant is a significant step forward in addressing the opioid epidemic and improving the health and well-being of patients. You can learn more about the NIH $9.8 million grant on the UT Health San Antonio School of Dentistry website.
The original grant approval contributed to a record annual total of $35 million in research grant funding for the School of Dentistry secured in the fiscal year 2022. Overall, UT Health San Antonio is the largest research institution in South Texas.
A study published in the Journal of the American Dental Association found that dental patients who received opioid prescriptions were more likely to become long-term users of the drugs.
Why dentists prescribe opioids and the risks involved
Dentists prescribe opioids to manage pain following dental procedures. They are often prescribed as pills, capsules, or tablets. While opioids can effectively manage pain, they come with several risks, including addiction, respiratory depression, and overdose.
In addition, long-term use of opioids can lead to tolerance, meaning that patients will need to take larger doses to achieve the same pain relief. This can increase the risk of addiction and overdose. For example, a patient with a chronic condition who takes opioids to curb the pain may require a higher concentration in the future.
Clinicians should also consider all medical conditions associated with the patient so as not to cause drug-drug interaction. For example, mixing a sedative medication with opioid pain medication will cause adverse effects. You can also check the Prescription Drug Monitoring Program (PDMP) database.
Alternatives to opioid pain management in dentistry
To reduce the number of opioid prescriptions by dentists, the patient and clinician should consider alternative pain management strategies. Discuss these options with your dentist and health care providers. Some options include:
- Over-the-counter pain relievers such as ibuprofen and acetaminophen
- Topical pain relievers, such as lidocaine gel or cream, can be applied directly to the affected area
- Non-opioid prescription medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
- Acupuncture, which is effective in managing dental pain
- Physical therapy and other forms of rehabilitation can help manage chronic pain
Long-term opioid use refers to using these drugs for extended periods, often several weeks or months. One of the most significant risks associated with long-term opioid use is addiction. Prolonged use of opioids can lead to physical dependence, which means that the body becomes accustomed to the drug and withdrawal symptoms occur when it is stopped. This can lead to a cycle of addiction where the patient feels the need to continue taking the drug to avoid withdrawal symptoms.
Training dentists to prescribe opioids more responsibly
Dentists must clearly understand the risks associated with opioid use. When prescribing opioids for dental procedures, dentists should choose the lowest effective dose for the shortest duration possible.
This helps minimize the risk of addiction or overdose while effectively managing pain. Although dentists cannot monitor the patient closely when they leave the office, they should inform the patient of potential overdose signs and symptoms.
Another important aspect of prescribing opioids is educating patients about the risks and benefits of opioid use. Dentists should provide clear and detailed information to patients about the potential dangers of opioid use, including the risk of addiction and overdose.
Dentists should also discuss alternative pain management options, such as non-opioid medications and non-pharmacologic techniques, and help patients make informed decisions about their care.
By following these best practices, dentists can help to reduce the risk of opioid addiction and improve patient outcomes. It’s important to note that dentists should always consult with the most updated and credible sources for guidelines and regulations before prescribing opioids.
Implementing guidelines for safe opioid prescribing in dental practice
Dental organizations, such as the American Dental Association (ADA) and the American Association of Oral and Maxillofacial Surgeons (AAOMS), have developed guidelines for safe opioid prescribing in dental practice.
These guidelines provide dentists with recommendations on how to safely prescribe opioids and how to monitor patients for signs of addiction or overdose. Below is a list of helpful guidelines and resources.
- The American Dental Association’s (ADA) Opioid Task Force: https://www.ada.org/en/member-center/oral-health-topics/opioids
- The National Institute on Drug Abuse’s (NIDA) page on opioids: https://www.drugabuse.gov/drugs-abuse/opioids
- The American Academy of Pain Medicine’s (AAPM) page on opioid therapy and chronic pain: https://www.painmed.org/patientcenter/facts_on_opioid_therapy/
- The American Society of Anesthesiologists’ (ASA) page on opioid use and alternatives for pain management: https://www.asahq.org/whensecondscount/pain-management/opioid-alternatives/
- The American Association of Oral and Maxillofacial Surgeons (AAOMS) page on opioid use and alternatives for pain management: https://www.aaoms.org/patient-resources/dental-health-library/analgesia-pain-control-after-oral-surgery
Patient education and communication strategies for reducing opioid use
Patient education and communication are crucial for reducing opioid use. Dentists should educate patients about the risks associated with opioid use and provide them with alternative pain management options. Here are some helpful resources if you or someone you know is struggling with opioid addiction.
Disclaimer: The resources provided are not intended to replace professional advice; you should always seek professional help first.
- Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: https://www.samhsa.gov/find-help/national-helpline
- American Society of Addiction Medicine (ASAM) directory of addiction treatment providers: https://www.asam.org/resources/find-a-treatment-provider
- The Partnership for Drug-Free Kids provides resources for families and caregivers of individuals struggling with addiction: https://drugfree.org/
Frequently asked questions (FAQ)
My Experience & Expertise
Dentistry plays a significant role in the opioid epidemic. Dentists are among the top prescribers of opioids, and dental procedures can often lead to long-term use. However, by understanding the risks associated with opioid use and implementing alternative pain management strategies, we can help curb the opioid epidemic.
Dentists should be trained to prescribe opioids more responsibly and follow guidelines for safe prescribing. Patient education and communication are also crucial for reducing opioid use. Working together can help patients receive the pain relief they need without risking their health.
Knowledge is power when cultivating healthy dental habits. The more informed you are, the better positioned you’ll be to prevent avoidable and potentially costly dental procedures for you and your family. Watch for future blog posts, where we’ll continue sharing important information, product reviews and practical advice!
- Chua KP. Persistent Opioid Use Associated With Dental Opioid Prescriptions Among Publicly and Privately Insured US Patients, 2014 to 2018. JAMA Netw Open. 2021.
- Dana R. Role of Dentists in Prescribing Opioid Analgesics and Antibiotics: An Overview. Dent Clin North Am. 2018.