Do Oral Surgeons Prescribe Too Many Narcotics for use after Wisdom Teeth Removal?

A new article published in the Journal of Oral and Maxillofacial Surgery is titled ” Narcotic Prescribing Habits and Other Methods of Pain Control by Oral and Maxillofacial Surgeons After Impacted Third Molar Removal,” by Ibrahim Mutlu, A. Omar Abubaker, and Daniel M. Laskin (vol. 71, pp. 1500-1503, 2013). The article explores the issue of whether or not oral surgeons regularly prescribe more than an adequate amount of narcotic pain killers to young adults after their wisdom teeth extraction. It has been believed by some that the narcotics given by oral surgeons for wisdom teeth removal can be a source of using narcotics for non-medical uses.

In this article a 8 question survey was sent to 100 randomly selected oral and maxillofacial surgeon members of the American Association of Oral and Maxillofacial Surgeon (AAOMS). The questions were related to whether narcotics were typically prescribed to patients who had impacted wisdom teeth removed, the dosage prescribed, and number of tablets prescribed. In addition, the oral surgeons were asked about non-narcotics prescribed to patients. In all 600 questionnaires were sent to oral surgeons and 384 of them were completed and returned.

The most commonly prescribed narcotic was found to be hydrocodone with the second most commonly prescribed oxycodone. A total of 328 of the 384 respondents reported the exact number of tablets prescribed which ranged from 10 to 40. Most respondents prescribed 20 tablets, but 80 respondents prescribed more than 20 tablets. A total of 36 respondents presented a range of the amount of tablets of narcotics prescribed. In this case, 13 reported prescribed a range of 20 or more tablets.

In the article, the authors describe how, based on clinical impressions, 20 tablets of narcotics taken 4 to 6 times daily is perceived as sufficient to control pain after wisdom teeth extraction. This is because one would expect the patient to take 6 tablets on the day of surgery, then 4 tablets each of the next 2 days, and potentially a few additional tablets on the fourth day. The authors suggest that if pain continues after the fourth day after wisdom teeth removal, then it is likely than an infection or dry socket (alveolar osteitis) has developed, and hence the patient should see the oral surgeon and not continuing taking narcotics. Based on the results of the study, 93 respondents were found to prescribe more than 20 tablets (including the range and non-range responders). Hence around 25% or so of the respondents prescribe what the authors declare as too many narcotics to control pain and opening the possibility of non-medical use of the additional narcotics prescribed.

The authors also mention that the use of a narcotic alone to control pain is often not sufficient. Hence, surgeons also use other methods which can include nonsteroidal anti-inflammatory drugs, steroids, and the injection of a long-lasting local anesthetic postoperatively.