Millions of healthy adolescents and young adults have their wisdom teeth pulled every year. Two of my three children had their impacted wisdom teeth extracted and undoubtedly the third will have his out when the time is right. In fact, wisdom tooth extraction is so common that it’s practically become a rite of passage for teens and young adults in this country. And oral surgeons often prescribe serious medication to treat the pain associated with those extractions and they prescribe that medication liberally.
Today in the United States we are facing an epidemic of addiction. For the first time in decades life expectancy in this country has gone down fueled largely by the fact that over 70,000 Americans died of a drug overdose in 2017. And many of those Americans were young.
When my children had their wisdom teeth extracted, their oral surgeon prescribed a small number of opioid pills for anticipated pain. Not knowing any better, I encouraged them to take the medication even before they felt significant pain because it had often been suggested to me that patients do best when they “stay ahead of their pain.” My kids, perhaps even most kids, could probably have gotten away with over-the-counter painkillers but when the doctor prescribes something, odds are you’re going to take it. Friends tell me that their children were prescribed 20 narcotic pills with an option for a 20-pill refill.
My intentions, and those of most parents, were good. I wanted to keep my children’s suffering to a minimum. Thankfully no harm came to them, but we all need to pay very close attention to a recently released study by JAMA Internal Medicine. The study sought to discover whether “opioid prescriptions from dental clinicians that are written for pain management of third molar extractions from adolescents and young adults associated with subsequent opioid use and abuse?” The answer is a strong maybe.
The study found that opioid prescriptions in adolescents and young adults who had not been exposed to opioids in the six-months prior were “associated with a statistically significant 6.8% absolute risk of persistent opioid use and a 5.4% increase in the subsequent diagnosis of opioid abuse.” That’s a big deal, a really, really big deal.
As parents we need to protect our children. We know that anyone who takes an opioid can become addicted. We also know that the cycle of addiction once begun is extremely difficult to stop. At some point in our culture, we became cavalier about the use of opioids for something relatively routine like wisdom tooth extraction. In 2017 more than 191 million opioid prescriptions for painkillers such as Vicodin and OxyContin were dispensed to American patients. Clearly some, maybe even most, of those prescriptions were warranted but as a rule do we need to give narcotics to healthy young adults who get their wisdom teeth pulled?
Clearly current literature suggests that the time has come to reexamine our attitudes towards opioids as a first line of defense against postoperative pain associated with wisdom-tooth removal. When there are a plethora of non-narcotic painkillers that can be offered as alternatives, that may actually work better than narcotics with fewer side effects, why introduce a kid to narcotics at this point? Doctors need to consider whether they are putting their patients at risk by prescribing opioids after wisdom tooth extraction. And, parents need to be careful to take the long view and do what is best for their kids with that in mind.
In a 2018 research letter entitled Persistent Opioid Use After Wisdom Tooth Extraction, a University of Michigan team looked into the issue of persistent opioid use in patients who were prescribed opioids after wisdom tooth removal. The team included U-M School of Dentistry professor Romesh Nalliah, DDS, MHCM who concluded that “…opioid prescribing for dental procedures can be cut to a fraction of what it is today,” he says. “Through wisdom tooth extraction, the dental profession has an enormous opportunity to fight the opioid crisis by preventing early introduction of opioids to America’s young people. We hope that our study will make my fellow dentists think twice about removing wisdom teeth, and to more strongly consider non-opioid solutions.”
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