Objective: Healthcare providers of all disciplines are greatly affected by the opioid epidemic. In order to reduce the misuse of opioids in dentistry, we must understand its role in our profession. The aim of this study was to compare the opioid prescribing habits for the management of dental pain by periodontists, endodontists, and oral surgeons in the United States. The study investigated the factors associated with the opioid prescription practices of these dental specialists and identified the proportion of opioid prescriptions for each type of dental procedure provided.
Methods: A 30-question anonymous survey using Qualtrics software was distributed electronically to periodontists, endodontists, and oral surgeons in the United States who had their email registered with the American Academy of Periodontology, American Association of Endodontists, and Accredited Advanced Education Programs in Oral Surgery member directory as of March 2020. The survey included questions about prescribing tendencies for specific procedures, rationale questions for choosing to prescribe or not to prescribe opioids, and demographic information. Results were analyzed using McNemar tests.
Results: Emails were sent out to 4,528 periodontists, 3,962 endodontists, and 100 oral surgeons. A total of 574 responses from periodontists, 523 from endodontists, and 30 from oral surgeons were collected. Periodontists were significantly less likely to report prescribing opioids for less-invasive surgeries, such as extractions and crown lengthening, and more likely to prescribe for more complex procedures, such as ridge augmentation (p<0.01). Endodontists were significantly more likely to report prescribing opioids for surgical treatment, but overall did not report a high prevalence of opioid prescriptions. Oral surgeons were significantly less likely to report prescribing opioids for less-invasive surgeries, such as simple extractions, and more likely to prescribe for more complex procedures, such as sinus augmentations (p<0.01). The main reason for not prescribing opioids for periodontists, endodontists, and oral surgeons was because NSAIDs and other analgesics were as or more effective than opioids. One of the most common reasons cited for prescribing opioids for various procedures was due to the fact that opioids required a written prescription and could not be called in, so writing the prescription in advance, eliminated the need to return to the office, especially during off-days and off-hours. Sixty-one percent of endodontists and sixty percent of periodontists responded that they would follow guidelines for opioid prescriptions if they were developed and endorsed by their respective academies. The American Association of Oral and Maxillofacial Surgeons released opioid prescribing recommendations in 2017. Oral surgery respondents cited these recommendations as the tool in their prescription decision-making.
Conclusion: Practitioners are more likely to prescribe opioids as procedure morbidity increases. Based on the results of this study, respondents would adhere to evidence-based guidelines. The establishment of these guidelines for practitioners on the appropriate use of opioids would be of benefit to dental specialists.