Opioids are commonly prescribed to relieve pain after tooth extraction. Understanding the differences in client-reported outcomes between opioid users and non-users could encourage the adoption of more conservative and appropriate prescribing practices in oral health medicine.
In a quality improvement study of 329 clients who underwent either surgical or routine extractions, clients who used opioids after the procedure reported higher levels of pain compared with non-opioid users. Those who did not use opioids reported similar satisfaction levels as the opioid users.
Abstract
Objective: To evaluate whether pain and satisfaction scores reported by clients who used opioids after tooth extraction were similar to the levels reported by clients with no opioid use.
Design, Setting, and Participants: This quality improvement study was conducted in the 14 dental clinics of the University of Michigan School of Dentistry. Eligible adult patients of these clinics who underwent routine or surgical extractions between June 1, 2017, and December 31, 2017, were contacted by telephone within 6 months of the procedure. Clients were surveyed about the type of extraction, use of prescription opioid (if given), use of non-opioid analgesics, pain levels, and satisfaction with care after the procedure. Data analysis was conducted from February 1, 2018, to July 31, 2018.
Main Outcomes and Measures: The primary outcome was self-reported pain as assessed by the question, “Thinking back, how would you rate your pain in the first week after your dental procedure?” with a 4-point pain scale of no pain, minimal pain, moderate pain, or severe pain. Secondary outcomes included self-reported satisfaction with care as assessed by a Likert scale ranging from 1 to 10, in which 1 was extremely dissatisfied and 10 was extremely satisfied.
Results: The final cohort comprised 329 clients, of whom 155 (47.1%) underwent surgical extraction (mean [SD] age, 41.8 [18.1] years; 80 [51.6%] were men) and 174 (52.9%) underwent routine extraction (mean [SD] age, 52.4 [17.9] years; 79 [45.4%] were men). Eighty clients (51.6%) with surgical extraction and 68 (39.1%) with routine extraction used opioids after their procedure. In both extraction groups, patients who used opioids reported higher levels of pain compared with those who did not use opioids (surgical extraction group: 51 [63.8%] vs 34 [45.3%], P < .001; routine extraction group: 44 [64.7%] vs 35 [33.0%], P < .001). No statistically significant difference in satisfaction was found between groups after surgical extraction (median [interquartile range] scores: 9 [7-10] for non-opioid group vs 9 [8-10] for opioid group) and routine extraction (median [interquartile range] scores: 10 [8-10] for non-opioid group vs 9 [7-10] for opioid group).
Conclusions and Relevance: This study found that clients who used opioids after tooth extraction reported significantly higher levels of pain compared with nonusers, but no difference in satisfaction was observed.
