Unnecessary wisdom tooth removal and opioid overprescribing go hand in hand

By Judith Garber | December 5, 2018

America’s opioid crisis has prompted researchers to examine clinicians’ opioid prescribing habits in recent years, finding some disturbing patterns of overuse. Dentists in particular have been under close scrutiny for opioid overprescribing, because they are most likely to prescribe opioids for adolescents. But despite efforts from public health and medical institutions to curb opioid prescribing, dentists prescribed 67% more opioids to patients age 11-18 in 2015 than they did in 2010.

A new study in JAMA Internal Medicine examines the consequences of opioid prescriptions for third molar (wisdom teeth) extraction. This study is the first to quantify persistent opioid use after dental procedures for patients age 16-25. Researchers found that patients who were prescribed opioids after the procedure were much more likely to exhibit signs of opioid addiction compared to patients who were not given the medication. Nearly 7% of patients given opioids received another opioid prescription 90 to 365 days later (compared to 0.1% of patients who were not originally given opioids) and 5.8% of patients given opioids later had an opioid abuse-related diagnosis.

The authors recommend that dentists use non-opioid alternatives after wisdom tooth removal, but also encourage closer scrutiny of wisdom tooth removal itself. They point out that wisdom tooth removal has other associated harms, including anesthesia complications (some of which have led to death) and antibiotic overuse.

Extracting wisdom teeth is expensive, painful, and often unnecessary. While oral surgeons warn that leaving in wisdom teeth can lead to cysts, infections, and damage to other teeth, there is little evidence to support these claims. In a study of 3,700 wisdom teeth that were impacted but left in, only 12% had caused any dental health problems twenty years later. The British National Health Service, finding insufficient evidence to reimburse the procedure, recommends not removing wisdom teeth if they’re not causing any problems.

“If third molar extractions are the primary source of exposure to opioids, given that the potential risks and complications of the procedure extend beyond the potential for opioid use and abuse and given the lack of evidence supporting removal of asymptomatic third molars, there is also a need to focus on potentially unnecessary procedures,” the authors write.

In other words, we should not just be asking, “Why are we prescribing so many opioids” but also, “Why are we doing so many wisdom teeth extractions?”

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.