Opioid prescribing in dentistry—is there a problem?

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opioid prescribing in dentistry
Photo: Aleksandr Davydov – 123rf

Dental prescribing of paracetamol with codeine increased by 21 per cent the year after the opioid medicine codeine was made prescription-only in February 2018, an Australian analysis has found. 

In an article in Australian Prescriber, dentist and pharmacist Dr Leanne Teoh from the University of Melbourne examines opioid prescribing in dentistry and explains how anti-inflammatory medicines like ibuprofen are often a more effective and safe option for managing dental pain.

“There is little role in dentistry for opioids given we have better alternatives available,” Dr Teoh said.

“Dental treatment is always the best way to manage dental pain. Many studies have shown that, when pain relief is needed, anti-inflammatory medicines such as ibuprofen are more effective and better tolerated than opioids. These pain medicines also reduce inflammation caused by dental conditions, while opioids only block the perception of pain.

“Furthermore, opioid medicines come with serious risks of harm, and there is evidence that people can become dependent on opioids as a result of codeine initiated for dental pain,” Dr Teoh added.

While codeine misuse and sales appear to have reduced overall since codeine was made a prescription-only medicine, dental prescribing of paracetamol with codeine has increased. Dentists may be targets of ‘doctor shopping’, in which people dependent on opioid medicines visit multiple prescribers to obtain them.

Real-time prescription monitoring programs give prescribers an up-to-date history of a person’s supply of high-risk medicines and can help identify patients with potential opioid-related problems,” Dr Teoh said.

“Providing dentists with access to these systems, currently only accessible by doctors, pharmacists and nurses, may be beneficial.”

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