By Joy Stephenson-Laws, J.D., Founder

If I asked you to identify patients who you believe run the most risk of becoming addicted to opioid painkillers, you would probably say those who had a major surgery, such as a hip replacement, or  those battling a painful disease, such as cancer, as the top candidates.  Someone having a root canal or tooth extraction would probably not make your list.  

But dentists prescribe very powerful painkillers. Approximately, 10 percent of opioid prescriptions (other than those for active cancer treatment, chronic pain or recent hospitalization) in the U.S. are prescribed by dentists. In fact, dentists are one of the top prescribers of this type of painkiller after family physicians.

Another somewhat surprising fact is that more than 22 percent of U.S. dental prescriptions were opioids.  This is a staggering percentage when compared to the 0.6 percent of English dental prescriptions that are opioids.  And, according to the U.S. Centers for Disease Control and Prevention (CDC), dental pain may result in the first encounter adolescents and young adults have with opioids.  

Given that your dentist may at some point offer you a prescription for an opioid painkiller after a procedure, there are some things you should keep in mind before heading to your local pharmacy.

It is true that opioid painkillers are undoubtedly indicated and appropriate for certain patients after a procedure. But it is also true that these medications are sometimes no more effective than widely available over the counter (OTC) medications. Opioids also carry various health risks that you need to consider before taking them or giving them to your family.

Some Risks of Taking Opioids for Dental Pain

Perhaps the greatest risk, according to a recent study from the University of Michigan, is that patients who filled an opioid prescription after a dental procedure have  higher overdose rates - more than two times higher than those that didn’t fill such a prescription. The study also found that overdose rates were higher among the family members of these patients. Researchers suggest the family member overdoses may possibly be due to their misuse of leftover opioid pain medications.

The study used data from 8.5 million teen and adult patients who had dental work over the span of seven years.  More than a quarter of these patients filled a prescription for an opioid painkiller. The study showed 2,700 overdoses within 90 days of tooth extraction or other dental procedure. The rate of overdose was more than double among patients who filled their prescriptions within three days of the procedure compared to those who didn’t.  It also turns out that patients with a history of substance abuse or with mental health conditions may be at higher risk of overdose after receiving prescriptions for opioid painkillers. 

Researchers further suggest that more than 1,500 overdoses a year could be attributable to dental opioid prescriptions. Put another way, fewer overdoses of an equal amount could possibly be prevented in the U.S. if dentists prescribed a medication other than opioids to their patients.

There is also evidence that patients are more likely to fill opioid painkiller prescriptions if they have a procedure on a Friday or on the day before a holiday.  In fact, this group of patients was 27 percent more likely to fill the prescription than those having procedures on other days of the week. That percentage jumped to 43 percent among teens and young adults.  The thinking is that patients having procedures on these days want to have the medications “just in case” to get them through the weekend or holiday so that they would not need to call the dentist if they were in pain. 

Another risk with opioids is that patients will continue to take the medications after they are no longer needed, which can readily set the stage for addiction.  For example, patients with wisdom tooth extractions are almost three times as likely to keep refilling these prescriptions well past when the extraction sites most likely were already healed.

Even if you take an opioid pain reliever as directed by your dentist, there is still the potential for side effects.  These could include:

• Developing a physical dependence (you have withdrawal symptoms when stopping the opioid)
• Increased sensitivity to pain
• Constipation
• Nausea, vomiting and dry mouth
• Sleepiness and dizziness
• Confusion
• Depression
• Low testosterone levels (can cause lower sex drive, energy, and strength)
• Itching
• Sweating
• Developing a tolerance (you need to take more of the medication for the same amount of relief)

Alternatives to Opioids for Dental Pain

If you are concerned about how to manage pain after a dental procedure, you will be glad to know that non-opioids such like ibuprofen (a nonsteroidal anti-inflammatory drug or NSAID) and acetaminophen (a different class of medication) are very effective for managing dental pain. 

There also is a relatively new OTC pain reliever that even combines ibuprofen and acetaminophen. 

Opioids are often no better for pain than these lower risk medications. Supporting this is the American Dental Association (ADA) policy that dentists should consider first prescribing NSAIDs alone or in combination with acetaminophen for post-procedure pain. These non-opioid options also have fewer side effects. 

How to be Proactive

I firmly believe, and most healthcare professionals agree, that patients who take a proactive role in their medical treatment often have better outcomes.  In the case of dental pain and how to best manage it, it is in your best interest to overcome any shyness you may have and be up front with your dentist about your concerns – and your personal preferences – for pain management. 

You also need to honest with your dentist about your medical history and the medications you take (including OTC products and any supplements).  Armed with this information, your dentist will be able to develop a pain management strategy that will work best for you.  Even if you have a great memory, also ask for written instructions on how much to take of the medications you agreed on and when to take them.  And don’t forget about other steps you can take to better manage pain, such as applying cool compresses.  

If you and your dentist agree that your procedure may require an opioid pain reliever, you should ask that the prescription be for the shortest number of days possible. This is because your risk of chronic use or abuse increases – and continues to increase – after three days of use.  If you find you no longer need the opioid after, let’s say, two days then you should discard whatever is left over (to protect both yourself and your family).  In many communities, you can easily drop them off at your local pharmacy, hospital, urgent care or even a long-term care facility such as a nursing home.  You also can get kits that let you discard medications at home. 

You should also discuss minerals with your doctor! You may be surprised to learn minerals can be quite beneficial for managing pain. Magnesium has anti-nociceptor effects, meaning it can keep the nociceptor (a sensory receptor for pain) from overreacting when it talks to your brain about the pain you are experiencing. Another mineral to keep in mind is zinc.  And fruit and vegetables may also help decrease pain (especially if you eat them on an ongoing basis) given their anti-inflammatory properties.  It is also important, from a dental perspective, to get enough vitamin C since being deficient in this vitamin can cause inflammation of the gums. 

Enjoy your healthy life!

Disclaimer: This article is not intended to provide medical advice. Please consult with your doctor or another competent healthcare practitioner to get specific medical advice for your situation.