Factors influencing opioid prescribing after tooth extraction

Education regarding opioid prescription within oral and maxillofacial surgery residency programs: a survey study

Background

The inappropriate use of opioids in the United States continues to pose a significant challenge to public health. For a look into how the next generation of practitioners may be trained, this survey study sought to evaluate the current opioid prescribing patterns among Oral and Maxillofacial Surgery (OMFS) residency programs in the United States.

Methods

A 16-question survey was sent to 100 residency program directors, with responses from 27 programs. The survey aimed to assess the program's strategies for postoperative pain management, including the use of opioids, non-opioids, and other available modalities such as localized long-acting bupivacaine.

Results

The results showed that 74% of the responding programs still taught the use of opioid prescriptions for third-molar removal, and 40% of the surveyed programs used prescription narcotics for other extractions as well. One-third of residency programs have adopted the use of localized long-lasting bupivacaine to limit the amount of narcotic medication required for dentoalveolar procedures.

Conclusion

This study highlights the implications of these prescription habits and raises questions regarding future improvements to OMFS resident training programs.

Alternatives to dental opioid prescribing after tooth extraction (ADOPT): protocol for a stepped wedge cluster randomized trial

BACKGROUND

Dentists and oral surgeons are leading prescribers of opioids to adolescents and young adults (AYA), who are at high risk for developing problematic opioid use after an initial exposure. Most opioids are prescribed after tooth extraction, but non-opioid analgesics provide similar analgesia and are recommended by multiple professional organizations.

METHODS

This multi-site stepped wedge cluster-randomized trial will assess whether a multicomponent behavioral intervention can influence opioid prescribing behavior among dentists and oral surgeons compared to usual practice. Across up to 12 clinical practices (clusters), up to 33 dentists/oral surgeons (provider participants) who perform tooth extractions for individuals 12-25 years old will be enrolled. After enrollment, all provider participants will receive the intervention at a time based on the sequence to which their cluster is randomized. The intervention consists of prescriber education via academic detailing plus provision of standardized patient post-extraction instructions and blister packs of acetaminophen and ibuprofen. Provider participants will dispense the blister packs and distribute the patient instructions at their discretion to AYA undergoing tooth extraction, with or without additional analgesics. The primary outcome is a binary, patient-level indicator of electronic post-extraction opioid prescription. Data for the primary outcome will be collected from the provider participant's electronic health records quarterly throughout the study. Provider participants will complete a survey before and approximately 3 months after transitioning into the intervention condition to assess implementation outcomes. AYA patients undergoing tooth extraction will be offered a survey to assess pain control and satisfaction with pain management in the week after their extraction. Primary analyses will use generalized estimating equations to compare the binary patient-level indicator of being prescribed a post-extraction opioid in the intervention condition compared to usual practice. Secondary analyses will assess provider participants' perceptions of feasibility and appropriateness of the intervention, and patient-reported pain control and satisfaction with pain management. Analyses will adjust for patient-level factors (e.g., sex, number of teeth extracted, etc.).

DISCUSSION

This real-world study will address an important need, providing information on the effectiveness of a multicomponent intervention at modifying dental prescribing behavior and reducing opioid prescriptions to AYA.

CLINICALTRIALS

GOV: NCT06275191.