American dentists urge curb on opioids

CHICAGO — The American Dental Association wants dentists to drastically cut back on prescribing opioid painkillers.

The association announced a new policy Monday that “essentially says eliminate opioids from your arsenal if at all possible,” said Dr. Joseph Crowley, the group’s president.

The Chicago-based organization represents around 161,000 dentists.

The group is also pushing for limiting opioid prescriptions to no more than a week and mandatory education for dentists that encourages using other painkillers.

Dentists write fewer than seven per cent of U.S. opioid prescriptions, but new research shows that practice has increased in recent years, despite evidence that ibuprofen and acetaminophen work just as well for most dental pain and are less risky opioids, which can be addictive.

In many dental cases involving opioids, dentists prescribe Vicodin or Percocet for shortterm pain from procedures including removing wisdom teeth and other tooth extractions, root canal work, or dental implants.

But nonsteroidal anti-inflammation drugs including ibuprofen (sold as Motrin and Advil) are as effective for these conditions; and ibuprofen plus acetaminophen (Tylenol) can provide better pain relief in some cases, according to an analysis of five studies published in the Journal of the American Dental Association.

Dentists are the leading prescribers of opioids for U.S. teens and the largest increase in dental prescriptions from 2010 to 2015 occurred in 11- to 18-year-olds, according to a study published in the same journal.

That rate climbed from almost 100 to 165 per 1,000 patients. Among all ages, the rate increased from 131 to 147 per 1,000.

The association said in a 2016 policy that dentists should consider these non-opioids as firstline treatment for pain.

“The fact that we’re still prescribing opioids when we’ve demonstrated that nonsteroidals are as effective most of the time is a little disturbing,” said Dr. Paul Moore, co-author of the analysis and professor at the University of Pittsburgh’s dental school.

In its new policy, the association supports making continuing education courses focusing on limiting opioid use a requirement for licensing dentists. Many states have adopted those mandates.

Moore noted that Pennsylvania recently enacted a law requiring dentists to get written consent from parents before prescribing opioids to patients under age 18.

For many young patients, “This is going to be their first experience with opioids,” Moore said.

“Maybe it is our opportunity to stop and counsel patients about the dangers.”