Implications of use of opioid-containing analgesics for palliation of acute dental pain

Abstract

Background: Initial palliation of acute dental pain with an opioid-containing pain reliever (OPR) is inappropriate but more likely to occur among the under- and uninsured who are unable to access the customary resources for dental care.

Objective: To assess the implications of palliation with an OPR, the authors determined the prevalence of several health attributes and socioeconomic status (SES) of patients taking prescription or over-the-counter (OTC) palliative medications before they presented to an academically affiliated dental clinic for definitive treatment of acute dental pain.

Methods: Prior palliation with any OPR/antibiotic combination was compared with a self-reported mood disorder, use of a psychotherapeutic or street drug, low SES (on Medicaid or self-payer), or high SES (having commercial dental insurance).

Results: Palliative medications were being taken by 34 percent of 851 patients including 20 percent who were taking an OPR. Use of any palliative prescription medication was significantly associated with low SES (odds ratio: 1.25; 95%; confidence interval: 1.35-2.88; p = 0.004). By comparison, high SES patients were significantly more likely to have used OTC analgesics or no medication (p < 0.001). Significantly more low SES patients self-reported mood disorders and street drug use (p = 0.048 and p = 0.019), respectively. Patients taking OPRs included those with self-reported mood disorders or use of a psychotherapeutic or street drug.

Conclusions: Palliation of acute dental pain with OPRs cannot resolve the underlying dental condition and contributes to drug misuse and adverse interactions. Preferable palliation should utilize combinations of non-OPR analgesics. These have fewer risks and may provide an incentive to seek definitive dental treatment.