How Are Dentists Reckoning With the Opioid Crisis?

Nearly 6 percent of teens and young adults given opioids after an extraction become addicted

Getting your wisdom teeth removed is, for many, a rite of passage into adulthood. For others, though, it’s a rite of passage into a full-blown opioid addiction. Eighteen-year-olds leave the oral surgeon’s office in a daze, with four empty sockets and a prescription for Vicodin, and while many are able to heal from the surgery, stop using the medication and move on, some quickly form a dependence that eventually leads them to heroin. 

There are numerous stories of young people becoming hooked on the drugs prescribed to them following a wisdom tooth extraction. In one shared by CBS News, a 22-year-old mother died of a heroin overdose just 15 months after her surgery; in another on Reddit, a 31-year-old formerly homeless addict cites the procedure as kickstarting his problems (“I had found my God,” he writes of his first hydrocodone prescription). A 2018 study from the Stanford University School of Medicine found that in the year following the procedure, nearly 6 percent of the 15,000 participants who had been prescribed an opiate-based drug were diagnosed with an opiate-abuse problem. By comparison, just 0.4 percent of the participants who had not been prescribed opioids were later diagnosed with substance abuse issues. 

As primary care doctors across the country are blamed for the opioid crisis — with some even being arrested for egregiously overprescribing — are dentists similarly being held responsible? 

Certainly, dentists have been among the dozens of medical professionals charged with crimes like accepting bribes, writing fraudulent prescriptions and performing unnecessary surgeries in order to dispense more opioids. But the larger problem is that, beyond outright criminal acts, there are no formal rules dictating how or why dentists may choose to prescribe opioids following wisdom tooth extractions — there are merely suggestions.

This may explain why, according to the American Dental Association (ADA), 18.5 million opioid prescriptions were written by dentists in 2012, accounting for 6.4 percent of all opioid prescriptions. (By 2017, that number had only decreased somewhat to 18.1 million.) In March 2018, the ADA finally adopted a policy regarding opioid prescriptions by dentists that calls for “mandatory continuing education regarding prescription of opioids and other controlled substances; statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain”; and that they utilize online prescription drug monitoring programs. However, the ADA merely supports these policies, rather than enforcing them — in other words, prescribing opiates remains a matter of dentists’ own discretion. 

ADA guidelines aside, with authorities looking more closely than ever at the doctors handing out these drugs, some dentists are choosing to avoid prescribing opiates entirely. This may be the right move in more ways than one: In April, researchers from the ADA Science Institute published a study that found that NSAIDs [nonsteroidal anti-inflammatory drugs] like ibuprofen — either alone, or in combination with acetaminophen — work as well, if not better, than opiates in treating acute dental pain. 

They still appear to be in the minority, though, considering that dental-related opioid prescriptions only declined by around 2 percent from 2012 to 2017. Meanwhile, an admittedly unscientific survey among my peers on Twitter who had their wisdom teeth removed showed that 80 percent of respondents were prescribed opiates. “I told the doctor/oral surgeon that I wouldn’t take opioids and preferred to take prescription-strength ibuprofen instead, and was prescribed opioids anyway. I just used the ibuprofen, and I still have the full bottle of oxy just sitting in a drawer,” says Julia de Aragón, a graduate student at Vanderbilt University. 

A few have noticed a shift, though. “I’ve had a fair amount of dental work over the past five or six years, and at least in NYC, it seems like dentists just don’t want to prescribe opioids unless it’s severe pain,” says Matthew Perpetua, a writer and former Director of Quizzes at BuzzFeed. “I think the last time I was prescribed opiates for that [dental work] was 10 years ago or longer.” 

As for myself, I recently consulted with an oral surgeon regarding my own future wisdom tooth extraction and was also told I’d be given a high dose of ibuprofen. I’ll be honest, at first, I not only felt nervous about the pain, I maybe even felt a bit cheated — doesn’t everyone get prescribed something strong for their wisdom teeth? But it’s probably for the best: Both my father and my sister are recovering opioid addicts, so considering my genetic predisposition, ibuprofen seems like the right choice. 

And maybe when it comes to wisdom teeth, it always has been.