The Opioid Epidemic and Its Connection to Dental Care

You’re in the dental chair, ready to have your wisdom teeth removed. You count down from 100, and in what feels like moments later, you wake up in a fog with a mouth full of gauze. A few hours later, it will probably hurt — but how much it hurts is different for everyone.

Approximately 5 million people had their wisdom teeth removed last year – the majority being teens and young adults. Having wisdom teeth removed is intensive oral surgery and, afterward, you may be prescribed opioid painkillers, such as Vicodin® or Percocet®. For many young people in the United States, wisdom tooth extraction is their first exposure to opioid painkillers and, in some cases, it may come with significant consequences. According to a study by the American Academy of Pediatrics, the use of prescribed opioids before 12th grade is associated with a 33% increase in future opioid misuse after high school.


Research supports that over-the-counter pain relievers, such as Tylenol® and Motrin®, may provide equal or superior relief of postoperative dental pain. Yet a study found 80% of people from ages 13 to 30 who had their wisdom teeth removed eventually filled an opioid prescription. And those who filled their prescription were nearly three times as likely to continue to use opioids in the year following.

Dr. Michael Mermigas, clinical director of national dental opioid policy at UnitedHealthcare, says oral health professionals write 12% of all opioid prescriptions, including 54% of opioid prescriptions for adolescents [1] – an age group especially vulnerable to addiction.

“Painkilling prescriptions are necessary and useful for some medical conditions. However, these powerful drugs come with a high risk of misuse and addiction,” said Dr. Mermigas. “It’s important to recognize the connection between dental care and opioids, and help dental professionals and patients make more informed treatment decisions.” 

With that in mind, UnitedHealthcare took multiple steps to limit teens’ exposure and inform dentists, patients and parents about opioid medications, including:  

  • Created a public toolkit focused on the connection between opioids and dental care, including commonly asked questions and a pain-management checklist for patients and parents to review with dentists or other dental health professionals. 
  • Adopted a pharmacy policy that limits all first-time opioid prescriptions for people age 19 and under to no more than three days and fewer than 50 morphine milligram equivalents per day, as recommended by the Centers for Disease Control and Prevention (CDC). This policy change resulted in an 89% reduction in the opioids prescribed outside of CDC guidelines. The guidelines were written by UnitedHealthcare network dental health professionals for plan participants age 19 and under.[2]
  • Identified dental health professionals in UnitedHealthcare’s network who consistently prescribed opioids outside the CDC guidelines. Following similar UnitedHealthcare outreach last year to more than 2,800 dental health professionals, prescribing patterns improved by 12%.[3]
  • Informed dental plan participants by e-mail about the risks associated with opioids, specifically in connection to wisdom-tooth extraction. The information aims to help parents and young adults better identify pain management alternatives and manage the frequency of use, dosage and proper disposal of unused opioids. 
  • Produced TV and radio public service announcements (PSAs) with Shatterproof, a national nonprofit organization dedicated to reversing the addiction crisis in the United States. Last year, the PSAs aired on nearly 400 stations across the country, in the hopes of helping parents and health professionals better understand the connection between oral health and the opioid epidemic.

Dr. Mermigas suggests to asking your dentist the following questions if you or a loved one are planning to have wisdom teeth removed or another oral surgery: 

  1. Do I really need to use opioids to manage my pain? 
  2. Are there alternatives to managing pain and what are they? 
  3. Will any of the medications I am currently taking interact poorly with opioids?
  4. How do I properly dispose of unused opioids?

Make sure to follow the directions from your dentist or doctor for pain management. Learn more about what UnitedHealthcare is doing to address the opioid epidemic.

 

[1] UnitedHealthcare pharmacy claims analysis representing more than 3 million claims, 2019

[2] UnitedHealthcare pharmacy claims analysis, 2019

[3] UnitedHealthcare pharmacy claims analysis, 2019