Pain Pills for Wisdom Teeth Extractions Could be Dangerous

Getting wisdom teeth removed may be a rite of passage for teens and young adults, but the accompanying opioid painkiller prescriptions many of them receive can lay a foundation for long-term opioid use, a new study finds. Patients in their late teens and 20s had the highest risk of persistent use if they received opioids around the time of their extraction.

Young people ages 13 to 30 who filled an opioid prescription immediately before or after wisdom teeth extraction were nearly 2.7 times as likely as their peers to still be filling opioid prescriptions weeks or months later. Those in their late teens and 20s had the highest odds of persistent opioid use compared with those of middle and high school age, a University of Michigan team reports in a research letter published this week in JAMA.

Led by Calista Harbaugh, M.D., a U-M research fellow and surgical resident, the researchers used insurance data to focus on young people who were “opioid naïve” — in other words, those who hadn’t received an opioid prescription in the six months before their wisdom teeth surgery and who didn’t have any other procedures requiring anesthesia in the following year.

“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need them for post-procedure pain,” says Harbaugh, a National Clinician Scholar at U-M's Institute for Healthcare Policy & Innovation.

“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction. We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription.”

Other factors also contributed to a risk of long-term opioid use. Teens and young adults who had a history of chronic pain conditions or mental health issues such as depression and anxiety were more likely than others to go on to persistent opioid use after filling their initial wisdom tooth-related prescription.

In all, 1.3 percent of 56,686 wisdom tooth patients who filled their opioid prescriptions between 2009 and 2015 went on to persistent opioid use — which is defined as two or more prescriptions filled in the next year written by any provider for any reason. Of the 14,256 wisdom tooth patients who didn’t fill an opioid prescription, only 0.5 percent went on to become persistent users.

The authors suggest that dentists and oral surgeons should first consider prescribing non-opioid painkillers to their wisdom tooth patients. If pain is acute, they should prescribe fewer pills than the seven-day opioid supply recently recommended by the American Dental Association for any acute dental pain. “There are no prescribing recommendations specifically for wisdom tooth extraction. With evidence that nonsteroidal anti-inflammatories may be just as, if not more, effective, a seven-day opioid recommendation may still be too much. If needed, opioids should only be used for breakthrough pain as backup if the pains not controlled with other medications,” says Harbaugh.

The research was funded by the federal Substance Abuse and Mental Health Services Administration, the Michigan Department of Health and Human Services, and University of Michigan Precision Health.

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