Opioid prescribing after nonsurgical root canal therapy: Findings from The National Dental Practice-Based Research...

Despite guidelines discouraging routine opioid use for localized endodontic infections, opioids continue to be prescribed after nonsurgical root canal therapy (RCT). The authors evaluated opioid prescribing patterns across a broad range of practice settings in the United States by means of engaging The National Dental Practice-Based Research Network.

Dental care practitioners collected standardized clinical, radiographic, and demographic data before and after RCT. The primary outcome was whether opioids were prescribed after treatment. Generalized estimating equation multivariable models were used to assess associations of dentist, patient, and clinical characteristics with opioid prescribing, accounting for clustering of patients within the dentist who performed the RCT.

A total of 153 dentists (104 general dentists, 49 endodontists) enrolled 1,723 patients requiring RCT. Opioids were prescribed to 263 patients (15%). In multivariable models, the authors found higher odds of opioid prescribing among patients who reported being somewhat through extremely afraid of the RCT (odds ratio [OR], 1.41; 95% CI, 1.15 to 1.74; P = .001), whose tooth was tender to palpation (OR, 1.36; 95% CI, 1.05 to 1.77; P = .030), or whose treatment was completed in 1 visit (OR, 1.51; 95% CI, 1.13 to 2.02; P = .008). The authors found lower odds of opioid prescribing when a radiolucency was present (OR, 0.77; 95% CI, 0.62 to 0.96; P = .040).

Opioid prescribing after RCT was associated with higher odds among patients with dental fear or tenderness to palpation and single-visit treatment and with lower odds when radiolucency was present.

Findings suggest opportunities to reduce opioid use in endodontics through better anxiety management, use of nonopioid analgesics, and targeted efforts in high-prescribing settings.