J Am Dent Assoc. 2021 Mar;152(3):209-214. doi: 10.1016/j.adaj.2020.12.002.
Nonopioids provide sufficient analgesia with less risk after most dental procedures, but opioid prescriptions are still common. This study analyzed opioid prescribing characteristics on the basis of patient demographics and procedure types.
The authors conducted a secondary analysis of an existing data set of opioid prescriptions issued from 2013 through 2018 from a college of dentistry in central Appalachia. Opioid prescriptions for young children or liquids were excluded. The authors analyzed prescriptions according to patient age group and sedation level required for surgical procedures.
Of 12,464 opioid prescriptions analyzed, 70% were written after extractions or surgical procedures. More than one-half (57.3%) were written for patients younger than 45 years. Adolescent and young adult (AYA) patients received prescriptions of higher quantities (mean [standard deviation], 20.9 [6.4] pills; 95% confidence interval, 20.6 to 21.1) and of longer durations (mean [standard deviation], 3.3 [1.5] days; 95% confidence interval, 3.2 to 3.4) than other groups (P < .001; 1-way analysis of variance).
AYA patients received more opioids than older patients after dental procedures, which is concerning given the high risk associated with AYA opioid exposure. Faculty in colleges of dentistry should educate students and residents on the risks and benefits of opioid therapy as well as alternative analgesics and via exemplifying appropriate prescribing behavior.
AYA patients represent a seemingly unidentified high-risk age group for dentists. Dentists who perform invasive procedures must examine carefully opioid prescription necessity and prescribe in a manner consistent with best practices.
大多数牙科手术后,非阿片类药物即可提供充分的镇痛效果,且风险较低,但阿片类药物的处方仍很常见。本研究基于患者人口统计学特征和手术类型分析了阿片类药物的处方特点。
作者对阿巴拉契亚中部一所牙科学院 2013 年至 2018 年期间开具的阿片类药物处方的现有数据集进行了二次分析。排除了给幼儿或液体开具的阿片类药物处方。作者根据患者年龄组和手术所需的镇静水平分析了处方。
在所分析的 12464 份阿片类药物处方中,70%是在拔牙或手术后开具的。超过一半(57.3%)是为年龄小于 45 岁的患者开具的。青少年和年轻成人(AYA)患者收到的处方数量(平均[标准差],20.9[6.4]片;95%置信区间,20.6 至 21.1)和持续时间(平均[标准差],3.3[1.5]天;95%置信区间,3.2 至 3.4)均长于其他组(P<.001;单因素方差分析)。
与其他年龄组相比,AYA 患者在牙科手术后接受的阿片类药物比老年患者更多,鉴于 AYA 接触阿片类药物的风险较高,这令人担忧。牙科学院的教师应通过展示适当的处方行为,并就阿片类药物治疗的风险和益处以及替代镇痛剂对学生和住院医师进行教育。
AYA 患者代表了一个牙医似乎未识别的高风险年龄组。进行有创性操作的牙医必须仔细检查阿片类药物处方的必要性,并以符合最佳实践的方式进行处方。