29 - Opioid Prescribing for Tooth Extraction Among U.S. Adolescents and Young Adults

Publication Number: 3026.29

Kao-Ping Chua, University of Michigan Medical School, ANN ARBOR, MI, United States; Chad Brummett, University of Michigan Medical School, Ann Arbor, MI, United States; Romesh P. Nalliah, University of Michigan School of Dentistry, Ann Arbor, MI, United States

Background: U.S. dentists prescribe more opioid prescriptions to adolescents and young adults (AYAs) aged 12-25 years than any other specialty. A prior study showed that tooth extraction accounted for 78% of dental opioid dispensing to AYAs in 2013-2018, even though randomized trials show that non-opioids are equally effective for pain after this procedure. It is unclear whether this finding generalizes to current practice. Moreover, the factors associated with opioid dispensing to AYAs after tooth extraction are unclear.

Objective: To determine the share of dental opioid dispensing to AYAs accounted for by tooth extraction; to identify the factors associated with opioid dispensing after tooth extraction.

Design/Methods: We conducted a cross-sectional, procedure-level analysis of the Merative MarketScan Dental, Commercial, and Multi-State Medicaid Databases, which include claims from privately and publicly insured patients across the U.S. We identified all surgical or emergent dental procedures for AYAs during 2021-2023. For each procedure, we determined whether there was a dispensed opioid prescription (prescription filled within 3 days). Among all dispensed opioid prescriptions in the sample, we calculated the proportion accounted for by tooth extraction. Using linear regression, we identified patient and procedure factors associated with having a dispensed opioid prescription after tooth extraction. We repeated analyses when limiting to privately insured patients and additionally controlling for rural residence and Census region, variables only available in the Commercial database.

Results: The 1,057,085 procedures in the sample were associated with 194,802 dispensed opioid prescriptions, of which tooth extraction accounted for 89.2%. Among 437,571 tooth extraction procedures, 39.7% were associated with a dispensed opioid prescription. Factors positively associated with having a dispensed opioid prescription included Medicaid insurance, having a mental health or substance use disorder, and having a procedure on Friday (Fig 1). Among the privately insured, residing in rural areas or the South were also positively associated with having a dispensed opioid prescription.

Conclusion(s): Tooth extraction accounts for 89% of dental opioid dispensing to AYAs. As dentists account for 42% of opioid prescriptions to AYAs, findings suggest 38% of all opioid dispensing to AYAs is for tooth extraction and thus could potentially be eliminated without worsening pain control. Efforts to achieve this elimination should be targeted towards certain patients, such as those in the South and those undergoing procedures before the weekend.

Figure 1. Factors associated with having a dispensed opioid prescription after tooth extraction among adolescents and young adults aged 12-25 years
tooth extraction pas abstract_figure.pdfThis forest plot displays coefficients from a linear regression model assessing the association between the characteristic and having a dispensed opioid prescription after tooth extraction. Point estimates represent absolute percentage-point differences compared to the reference category.