J Am Dent Assoc. 2018 Apr;149(4):246-255. doi: 10.1016/j.adaj.2018.02.010.
BACKGROUND: The objective of this study was to identify specific factors (sex, race or ethnicity, and health care provider type) associated with patient receipt of an opioid prescription after a dental diagnosis. METHODS: The authors used Medicaid claims dated from January 1, 2013, through September 30, 2015, for 13 US states in this study. The authors identified oral health-related conditions by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes 520.0 through 529.9. RESULTS: During the 2013-2015 study period, among the more than 890,000 Medicaid patients with a dental diagnosis, 23% received an opioid within 14 days of diagnosis. Female patients were 50% more likely to receive an opioid for pain management of a dental condition than were men (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.52 to 1.55). Non-Hispanic whites and African Americans were approximately twice as likely to receive opioids than were Hispanics (OR, 2.11; 95% CI, 2.05 to 2.17 and OR, 1.88; 95% CI, 1.83 to 1.93, respectively). Patients receiving oral health care in an emergency department were nearly 5 times more likely to receive an opioid prescription than were patients treated in a dental office (OR, 4.66; 95% CI, 4.59 to 4.74). Patients with a dental condition diagnosed were nearly 3 times as likely to receive an opioid from a nurse practitioner as from a dentist (OR, 2.64; 95% CI, 2.57 to 2.70). Opioid use was substantially higher among African American female patients (OR, 3.29; 95% CI, 3.18 to 3.40) and non-Hispanic white female patients (OR, 3.24; 95% CI, 3.14 to 3.35) than among Hispanic female patients. CONCLUSIONS: Opioid prescribing patterns differ depending on patient race or ethnicity, sex, and health care provider source in patients with a dental diagnosis in the United States. PRACTICAL IMPLICATIONS: Dentists are providing substantially less opioid prescriptions compared to their medical colleagues for pain treatment following a dental diagnosis in the Medicaid population. When considering pain management for dental and related conditions, dentists should continue with conservative prescribing practices as recommended.
背景：本研究旨在确定与牙科诊断后患者接受阿片类药物处方相关的特定因素（性别、种族或民族以及医疗服务提供者类型）。
方法：本研究使用了来自 2013 年 1 月 1 日至 2015 年 9 月 30 日的 13 个美国州的医疗补助索赔数据。作者通过使用国际疾病分类，第九版，临床修正诊断代码 520.0 至 529.9 来确定与口腔健康相关的病症。
结果：在 2013-2015 年的研究期间，在超过 890,000 名有牙科诊断的医疗补助患者中，23%的患者在诊断后 14 天内接受了阿片类药物治疗。女性患者接受牙科病症疼痛管理的阿片类药物治疗的可能性比男性高 50%（优势比[OR]，1.53；95%置信区间[CI]，1.52 至 1.55）。非西班牙裔白人和非裔美国人接受阿片类药物的可能性是非西班牙裔西班牙裔的两倍（OR，2.11；95%CI，2.05 至 2.17 和 OR，1.88；95%CI，1.83 至 1.93）。在急诊室接受口腔保健的患者接受阿片类药物处方的可能性几乎是在牙科办公室接受治疗的患者的 5 倍（OR，4.66；95%CI，4.59 至 4.74）。患有牙科诊断的患者接受执业护士开出的阿片类药物处方的可能性几乎是接受牙医开出的处方的 3 倍（OR，2.64；95%CI，2.57 至 2.70）。非西班牙裔美国黑人女性患者（OR，3.29；95%CI，3.18 至 3.40）和非西班牙裔白人女性患者（OR，3.24；95%CI，3.14 至 3.35）接受阿片类药物的可能性明显高于西班牙裔女性患者。
结论：在美国有牙科诊断的患者中，阿片类药物的开具模式因患者的种族或民族、性别和医疗服务提供者来源而异。
实际意义：与医疗补助人群中接受牙科诊断后的疼痛治疗相比，牙医开具的阿片类药物处方明显少于他们的医学同行。当考虑到牙科和相关病症的疼痛管理时，牙医应继续遵循保守的处方实践。
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