Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal?

An interesting article titled “Do Oral and Maxillofacial Surgeons Over-Prescribe Opioids After Extraction of Asymptomatic Third Molars?” written by Resnick et al. appears in the 2019 edition of the Journal of Oral and Maxillofacial Surgery. The authors perform a study using patients at Boston Children’s Hospital in Boston, Massachusetts to determine how many opioids (taken as oxycodone) they take after having wisdom teeth extracted. This study was motivated by some recent studies that has shown that patients given opioids for dealing with pain after wisdom teeth surgery can go on to abuse opioids, see for example the posts Opioid Prescriptions From Dental Clinicians for Young Adults and Subsequent Opioid Use and Abuse and Persistent Opioid Use After Wisdom Teeth Removal.

In the article the authors devised a study to determine how many narcotic and non-narcotic pain relief pills are taken in the first week after surgery in a group of healthy patients who each had all four wisdom teeth extracted. The authors included patients ages 14 to 25 years old who had their surgery performed at Boston Children’s Hospital by one of three possible oral and maxillofacial surgeons. For each of the seven days after surgery each patient received an email link with a questionnaire asking them to indicate the number of ibuprofen, acetaminophen, oxycodone and any other pain relief medications taken the previous day. An additional questionnaire on the seventh day after surgery asked the patients how many remaining oxycodone pills they had and how they were going to dispose of them. The patients were told to take ibuprofen and acetaminophen if they experienced minor to moderate pain and to take oxycodone for severe pain. The patients were given a prescription for 6 oxycodone 5 mg tablets, 20 ibuprofen 600 mg tablets, and 40 acetaminophen 325-mg tablets. In total there were 104 patients that completed all seven days of the survey after wisdom teeth surgery but only 81 of these patients were used for determining the results of the study due to issues with survey completion or other medical issues.

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The authors found that only 6 of the 81 patients (7%) took oxycodone at least once in the week after surgery. Among these six patients the average number of oxycodone tablets used was 3.3 tablets. Among these six patients four of them took oxycodone the second day after surgery and none of them took oxycodone after 5 days of surgery or more. The authors found that 466 of the 486 prescribed oxycodone tablets (96%) were either not used or never filled at a pharmacy. It was found that ibuprofen 600 mg was used by 72 patients (89%) for an average amount of time of 4.6 days and acetaminophen 650 mg was taken by 70 patients (86%) for an average amount of time of 3.4 days. All of the medications (acetaminophen, ibuporfen, and oxycodone) were used the most frequently on the second day after surgery. There were also nine patients that used other pain relief medications other than acetaminophen, ibuporfen, and oxycodone. The authors found that females were more likely than males to take a pain relief medication after wisdom teeth removal, a value that was statistically significant.

The authors state:

“…very few patients used postoperative opioid medication after removal of asymptomatic third molars [wisdom teeth] with intravenous sedation in the outpatient setting. OMSs [oral and maxillofacial surgeons] should consider decreasing or eliminating empiric narcotic prescribing after this procedure.”

The authors do point out several limitations with their study including using only a single hospital for the patients that may not apply to typical beliefs in other geographical regions and possible reporting bias due to the fact that the patients included in the study were all volunteers. The authors also say that patients could have not wanted to report their true amount of oxycodone or possibly subconsciously alerted how much they took because they knew they were reporting it.

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