It is unknown which procedures account for the most US dental opioid prescriptions.
Moreover, few national studies have assessed opioid prescribing patterns for these
procedures. These knowledge gaps impede the optimal targeting of dental opioid stewardship
The authors analyzed claims data from the 2013 through 2018 IBM MarketScan Dental,
Commercial, and Medicaid Multi-State Databases. Patients aged 13 through 64 years
undergoing 1 of 120 procedures were identified. “Initial prescriptions” were opioid
prescriptions dispensed on the date of procedures to 3 days afterward. For the procedures
accounting for the 5 highest proportions of initial prescriptions, the authors fitted
linear regression models assessing trends in the probability of 1 or more initial
prescriptions and mean total morphine milligram equivalents prescribed—a standardized
measure of opioid amount. Regressions were adjusted for demographic characteristics
The 9,482,976 procedures in the sample were associated with 2,721,688 initial prescriptions.
Of these prescriptions, 5 procedures accounted for 95.2%: tooth extraction (65.2%),
problem-focused limited oral evaluation (17.2%), endodontic therapy (8.4%), alveoloplasty
(2.9%), and surgical implant services (1.5%). Among the 5 procedures, the median adjusted
annual change in the probability of 1 or more initial prescriptions was −1.3 percentage
points. The median adjusted annual change in mean total morphine milligram equivalents
was −4.5 (roughly 1 pill containing 5 mg of hydrocodone). In 2018, 45.3% of tooth
extractions resulted in 1 or more initial prescriptions.
Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction
accounted for almost two-thirds of those. Opioid prescribing for tooth extractions
is declining but remains common, despite the availability of equally effective nonopioid
Eliminating routine opioid prescribing for tooth extraction could reduce dental opioid