During National Children’s Dental Health Month, Let’s Discuss the Risks of Dental Opioid Prescriptions
Feb 19, 2019
February is National Children’s Dental Health month, an observance sponsored by the American Dental Association (ADA) that brings together healthcare providers and educators to promote the benefits of good oral health to children and their caregivers.
This year, the ADA’s theme is Brush and clean in between to build a healthy smile!? But for dentists and teens, the most important lesson of children’s dental health could come through increased education about a danger far more serious than plaque: an opioid prescription.
That’s because the first time that many American teens receive a prescription for opioid painkillers is at the dentist’s office. While teens in other countries are rarely prescribed opioids after dental surgeries like wisdom tooth removal, American teens are much more likely to be prescribed highly addictive drugs such as Vicodin.
And the danger of addiction is real. A majority of all heroin users started by taking prescription painkillers, including oxycodone, hydrocodone, codeine, and morphine.
A 2015 study in the journal Pediatrics found that prescribed opioid use makes teens 33% more likely to abuse opioids later on. A more recent study, published last December in JAMA Internal Medicine by the Stanford University School of Medicine, found that teens and young adults who receive an initial opioid prescription from their dentists or oral surgeons are at increased risk for opioid addiction as soon as the following year.
Big risk going unnoticed
The opioid epidemic claims tens of thousands of lives each year, and addiction often begins with a prescription. As reported in a 2018 study in the Journal of the American Dental Association, more than two-thirds of opioids are prescribed after dental surgery, for procedures such as wisdom tooth removal, root canal treatment and gum surgery.
Because of the developing teen brain, teens are at higher risk of Opioid Use Disorder (OUD) than adults.
For every 50 opioid prescriptions written in the U.S., three are written by a dentist. According to the ADA study, dentists prescribed more opioids in 2015 than they did in 2010, especially for patients between the ages of 11 and 18 years old. This group was also prescribed the strongest dosage of opioids.
In the face of a crippling opioid epidemic and the heightened risk for children, why are dental prescriptions of opioids for teens on the rise?
The wisdom of wisdom tooth removal
For teens, dental opioid prescriptions accompany wisdom tooth removal more than any other procedure.
That?s why the Stanford study posed the question: is it necessary to prescribe opioids after this surgery, and is the procedure itself necessary?
While extremely common, wisdom tooth extraction is less understood than you?d think. According to a 2016 Cochrane review of this topic, removal of disease-free wisdom teeth has not been studied thoroughly enough to determine whether it benefits patients.
The Stanford study concluded that more research would be necessary to determine how needed these extractions really are.
What?s not in doubt is the effect of opioid prescriptions after the extraction. The Stanford study found that the youngest patients, ages 16 to 18, were significantly more likely to have persistent opioid use than the oldest patients, ages 22 to 25. And female patients were more likely than male patients to have persistent opioid use.
Protecting your teen from addiction while treating dental pain
Parents should understand whether their child?s prescriptions are opioids, and they should seek non-opioid alternatives if possible.
The ADA suggests that over-the-counter treatments – such as a combination of ibuprofen (such as Advil) and acetaminophen (also known as paracetamol or Tylenol) – should be the first line of defense for dental pain.
People don?t get addicted to Tylenol and Advil, and these are remarkably effective treatments. In fact, a 2013 study in the Journal of the American Dental Association found that a 200 mg dose of ibuprofen with a 500 mg of acetaminophen is more effective than any other combination of drugs, including opioids.
If your child must have an opioid prescription, carefully manage the usage of this medication. Return leftover medication to the pharmacy for proper disposal so that these drugs aren?t overused or diverted to others.
Talk to your children about the dangers of opioids and the potential of ?recreational? misuse of opioids by their friends.
If your child does develop a dependence on opioids, seek the right help. For children under 16, child behavioral units can provide support. For teens and young adults over 16, look for evidence-based, physician-supervised medical intervention.