Opioid prescribing for tooth extraction in the United States, 2021 through 2023

Compared with opioids, ibuprofen and acetaminophen are safer and equally effective options for analgesia after tooth extraction. Despite this, researchers found that tooth extraction accounted for 65% of opioid prescriptions dispensed after dental procedures from 2013 through 2018. It is unclear whether this proportion has since changed. In addition, the factors associated with opioid dispensing after tooth extraction are unclear.

The authors conducted a cross-sectional analysis of the Merative MarketScan Dental, Commercial and Multi-State Medicaid Databases, which include dental and pharmacy claims from privately and publicly insured patients. Analyses included dental procedures for patients aged 13 through 64 years from 2021 through 2023. The authors counted the number of opioid prescriptions dispensed within 3 days of these procedures and calculated the proportion of these dispensed opioid prescriptions accounted for by tooth extraction. Among patients undergoing tooth extraction, the authors used linear regression to identify patient and procedure factors associated with having a dispensed opioid prescription.

The 3,643,224 procedures in the sample were associated with 569,729 dispensed opioid prescriptions, of which tooth extraction accounted for 76.2%. Among 1,290,061 tooth extractions, the opioid dispensing rate was 33.7%. For surgical and nonsurgical extractions, the rates were 45.7% and 19.0%, respectively. Factors positively associated with opioid dispensing included residence in the South, undergoing the procedure on a Friday, and having a mental health disorder.

Tooth extraction remains the dominant indication for dental opioid prescribing.

Dental opioid stewardship initiatives may be most efficient if they focus on reducing opioid prescribing after tooth extraction.