Pharmacologic Management of Non-Traumatic Dental Conditions in US Emergency Departments, 2018-2022

This study examines opioid and antibiotic prescribing by United States emergency departments (EDs) for non-traumatic dental conditions (NTDCs) between 2018 and 2022.

This is a secondary analysis of nationally representative ED visits using the National Hospital Ambulatory Medical Care Survey (NHAMCS) with an NTDC as the primary discharge diagnosis. Descriptive statistics and odds ratios using chi-squared testing and multivariable logistic regression were used to examine analgesic and antibiotic prescriptions, as well as patient, visit, and hospital characteristics.

There were 1,838,729 weighted ED visits for NTDCs between 2018 and 2022, 1.3% of all visits. Findings demonstrate a continued decline in NTDC visits resulting in an opioid, with an increase in those with non-opioids. Overall, 25% of NTDC visits included an opioid analgesic in 2022, compared to 33% in 2018. The proportion of visits with non-opioid analgesics increased over the study period; nearly 60% of NTDCs seen in 2020 included a non-opioid analgesic. Overall, 63% included an antibiotic, with the highest proportion observed in 2020 (70%). No increase in the proportion of ED visits for NTDCs was seen between the pandemic years (2020-2022) and the pre-pandemic period (2018-2019).

Antibiotics and non-opioid analgesics were a common approach used by ED providers during the pandemic years. Opioid prescriptions for NTDCs declined between 2018 and 2022, while antibiotic prescriptions remained roughly stable. Reducing avoidable opioid and antibiotic prescriptions, and more broadly ED visits for NTDCs, requires a comprehensive approach.