Risks and mitigations of substance use disorders with dental procedures-related opioid prescriptions: A systematic...

Dental opioid prescriptions remain one of the most common initial exposures to opioids worldwide. Although opioid prescribing in dentistry has declined, even limited exposure to opioids may be a significant risk factor for developing Opioid Use Disorder (OUD), particularly in younger populations. This review evaluates the existing literature on dental opioid prescriptions and the development of OUD, identifies procedural and patient-related risk factors, and assesses the effectiveness of existing intervention strategies. Following the PRISMA guidelines, a comprehensive literature search was conducted across MEDLINE, Embase, PsycINFO, Web of Science, and CENTRAL from January 2011 to July 2026. Eligible studies examined opioid prescribing in dental alveolar surgeries, related OUD/SUD outcomes, and preventative interventions. From an initial 1008 identified records, 12 studies met the final inclusion criteria for qualitative synthesis. Observational studies showed that factors significantly associated with persistent opioid use or adverse outcomes included higher prescribed opioid doses, prior substance use disorder, public or Medicaid insurance, younger age, female sex, and complex chronic medical conditions. Notably, patients undergoing low-pain dental procedures who received opioids demonstrated the highest relative risk for short-term persistent use. Five studies evaluated interventions, finding that short behavioral counseling and opioid-sparing pharmacologic strategies, specifically liposomal bupivacaine and preemptive intravenous paracetamol, effectively reduced postoperative opioid consumption. However, none of the included intervention studies had sufficient follow-up to evaluate the direct prevention of clinical OUD. Future research should prioritize prospective longitudinal studies and randomized controlled trials to evaluate interventions that safely reduce opioid exposure and definitively prevent OUD following dental procedures.