J Am Dent Assoc. 2021 Apr;152(4):309-317. doi: 10.1016/j.adaj.2021.01.001. Epub 2021 Feb 23.
It is unknown which procedures account for the most US dental opioid prescriptions. Moreover, few national studies have assessed opioid prescribing patterns for these procedures. These knowledge gaps impede the optimal targeting of dental opioid stewardship initiatives.
The authors analyzed claims data from the 2013 through 2018 IBM MarketScan Dental, Commercial, and Medicaid Multi-State Databases. Patients aged 13 through 64 years undergoing 1 of 120 procedures were identified. "Initial prescriptions" were opioid prescriptions dispensed on the date of procedures to 3 days afterward. For the procedures accounting for the 5 highest proportions of initial prescriptions, the authors fitted linear regression models assessing trends in the probability of 1 or more initial prescriptions and mean total morphine milligram equivalents prescribed-a standardized measure of opioid amount. Regressions were adjusted for demographic characteristics and comorbidities.
The 9,482,976 procedures in the sample were associated with 2,721,688 initial prescriptions. Of these prescriptions, 5 procedures accounted for 95.2%: tooth extraction (65.2%), problem-focused limited oral evaluation (17.2%), endodontic therapy (8.4%), alveoloplasty (2.9%), and surgical implant services (1.5%). Among the 5 procedures, the median adjusted annual change in the probability of 1 or more initial prescriptions was -1.3 percentage points. The median adjusted annual change in mean total morphine milligram equivalents was -4.5 (roughly 1 pill containing 5 mg of hydrocodone). In 2018, 45.3% of tooth extractions resulted in 1 or more initial prescriptions.
Five procedures accounted for 95.2% of dental opioid prescriptions, and tooth extraction accounted for almost two-thirds of those. Opioid prescribing for tooth extractions is declining but remains common, despite the availability of equally effective nonopioid alternatives.
Eliminating routine opioid prescribing for tooth extraction could reduce dental opioid exposure substantially.
尚不清楚哪些程序导致了美国牙科阿片类药物处方的大部分。此外，很少有全国性研究评估过这些程序的阿片类药物处方模式。这些知识空白阻碍了牙科阿片类药物管理计划的最佳目标定位。
作者分析了 2013 年至 2018 年 IBM MarketScan 牙科、商业和医疗补助多州数据库中的索赔数据。确定了年龄在 13 至 64 岁之间接受 120 种程序之一的患者。“初始处方”是指在程序日期后的 3 天内发放的阿片类药物处方。对于占初始处方比例最高的 5 种程序，作者拟合了线性回归模型，以评估 1 种或多种初始处方的概率和规定的总吗啡毫克当量平均值（一种标准化的阿片类药物数量测量方法）的趋势。回归调整了人口统计学特征和合并症。
样本中的 9482976 例程序与 2721688 例初始处方相关。这些处方中，有 5 种程序占 95.2%：拔牙（65.2%）、问题导向的有限口腔评估（17.2%）、牙髓治疗（8.4%）、牙槽成形术（2.9%）和外科植入物服务（1.5%）。在这 5 种程序中，1 个或多个初始处方的概率的中位调整年度变化为-1.3 个百分点。规定的总吗啡毫克当量平均值的中位调整年度变化为-4.5（大致相当于 1 片含有 5 毫克氢可酮的药丸）。2018 年，45.3%的拔牙导致 1 个或多个初始处方。
有 5 种程序占牙科阿片类药物处方的 95.2%，而拔牙占其中的近三分之二。尽管有同样有效的非阿片类药物替代方案，但拔牙的阿片类药物处方仍在减少，但仍很常见。
消除拔牙的常规阿片类药物处方可以大大减少牙科阿片类药物的暴露。
