Dentist-reported practice-related challenges and patient-reported clinical adverse effects following the use of opioid and non-opioid medications to manage acute dental pain following tooth extraction or from toothache

The purpose of this exploratory study was to describe the types and frequencies of practice-related challenges associated with opioid and non-opioid management of acute dental pain experienced by dentists, such as patients challenging the dentist, requesting a different pain medication, or contacting the dentist after hours for additional pain medication, and clinical adverse effects experienced by patients, such as dizziness or drowsiness. Dentists from across the United States and patients from the U.S. South completed surveys assessing their experience of practice-related challenges and clinical adverse effects. Dentists were eligible if they treated patients for simple or surgical tooth extractions or toothache in a typical month. Patients were eligible if they had obtained treatment from a dentist for a simple or surgical tooth extraction or toothache in the prior two weeks. Data were analyzed using descriptive statistics. Ninety patients and 77 dentists participated in the study. Non-opioid pain medication was taken by 73 (81%) patients; opioid medication was taken by 2 (2%) patients; and 15 (16.7%) patients took no pain medication. Less than 3% of patients reported experiencing clinical adverse effects, and those experienced were generally mild. Opioids were never prescribed by 29 (37.7%) dentists; and opioids were prescribed by (62.3%) dentists. Over 80% of dentists reported practice-related challenges; however, 92% of those who experienced practice-related challenges reported that they occurred with fewer than half their patients. Over 31% of dentists who do not prescribe opioids reported never experiencing practice-related challenges compared with 10.4% of dentists who do prescribe opioids, $${\chi}^{2}$$(1) = 5.17; p = .02. In this exploratory study, few patients experienced clinical adverse effects from the pharmacologic management of acute dental pain regardless of the diagnosis, procedure, or pharmacologic management approach adopted. Dentists who prescribed opioids experienced practice-related challenges more frequently than dentists who do not prescribe opioids. Future research should determine whether by switching from opioid to non-opioid-containing medication, dentists are able to reduce the practice-related challenges they experience without increasing the clinical adverse effects their patients experience.