Opioid prescribing in dentistry – is there a problem?

Dental prescribing of paracetamol with codeine increased by 21% the year after the opioid medicine codeine was made prescription-only in February 2018. In a new 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,” says Dr Teoh. “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,” she says.

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

Another article in this edition of Australian Prescriber, by Dr Malcolm Dobbin from the Victorian Government of Health and Human Services and Dr David Liew from Austin Health, takes a more in-depth look at managing patients identified by real-time prescription monitoring.

Read the full Australian Prescriber article on opioids and dental pain.

Read the full Australian Prescriber article on real-time prescription monitoring.