Factors Associated with Opioid and Antibiotic Prescribing at US Academic Dental Institutions: 2011 to 2020

In the United States, dentists are one of the leading prescribers of opioids and antibiotics. Because dental schools are the training grounds for future dentists, it is crucial to understand how prescribing has changed and why these medications are being prescribed in academic settings.

The objective of this research was to describe the prescribing trends and factors associated with opioid and antibiotic medication prescribing at US academic dental institutions between 2011 and 2020.

Data from electronic dental records collected through the BigMouth data repository from 9 anonymized dental institutions between 2011 and 2020 were used. Prescribing rates were defined as the percentage of patients who received an opioid/antibiotic prescription. The primary outcome was whether at least 1 opioid or antibiotic medication was prescribed at the encounter. Monotonicity and statistical significance of prescribing trends by year were assessed using the Mann-Kendall test, and a statistical analysis using an adjusted multilevel mixed-effects logistic regression model was performed to identify significant patient-, visit-, and dental provider-level factors associated with prescribing of these medications.

In total, 5,720,166 patient encounters from 905,426 patients had aggregate opioid and antibiotic prescribing rates of 2.0% and 2.7%, respectively, between 2011 and 2020. For both medications, a downward prescribing trend was observed from 2013, which increased in 2020. Opioid prescribing was most likely for young adults aged 15 to 24 y (odds ratio [OR] = 5.26;95% confidence interval [CI]: 4.99-5.55) and by oral surgeons (OR = 10.03; 95% CI: 8.02-12.55). Antibiotic prescribing had a higher odds for patients aged >65 y (OR = 5.04; 95% CI: 4.62-5.49) and by periodontists/implant specialists (OR = 6.21; 95% CI: 4.96-7.78). Multiple treatments at the same dental visit and pain-associated dental procedures were associated with statistically significantly higher odds of being prescribed both medications.

There are significant differences in opioid and antibiotic prescribing by dentist specialty, patient age, whether the dental visit had multiple treatment procedures, and whether 1 or more postoperative dental pain-associated procedures were performed.Knowledge Transfer Statement:This study provides an understanding of patient-, dentist-, and visit-level factors associated with opioid and antibiotic medication prescriptions issued by clinicians at academic dental institutions in the United States. The results can contribute further to predict clinical scenarios related to the prescribing of these medications and the development of specific interventions to reduce inappropriate and excessive opioid and antibiotic medication prescribing.