Opioid and Antibiotic Prescribing in the US Academic Dental Setting
Abstract
Background: In the United States, dentists are responsible for millions of opioid and antibiotic medication prescriptions annually and have been recognized as the one of the leading healthcare professionals to be prescribing opioids and third leading prescribers of antibiotics, thereby contributing to the opioid crisis and antibiotic resistance. Clinically, opioids and antibiotics are frequently inappropriately prescribed for managing acute dental conditions, where they may be of little clinical benefit, as such ignoring established guidelines for prescribing these medications. Methods: In this research, factors associated with prescribing of opioids and antibiotics by dentists at academic dental institutions in the US were determined through quantitative and qualitative data analysis. For the quantitative analysis, data from electronic dental records collected through the BigMouth data repository from 9 dental institutions across the years 2011 – 2020 was used. Prescribing rates were calculated, trends in prescribing assessed and statistical analysis using multi-level mixed effects logistic regression model was performed to identify the factors associated with prescribing. For the qualitative analysis, 10 dental care providers at 1 dental institution were interviewed in the year 2020 and the data was analyzed using thematic analysis method to determine the behavioral factors that influence opioid prescribing behaviors. Lastly, adherence to prescribing guidelines was determined by reviewing 200 electronic dental records with opioid and antibiotic prescriptions during the year 2021 at 1 dental institution. Results: The opioid prescribing rate between the years 2011 – 2020 was 2.00% which saw a sharp decline from 2014 to 2019 and increased in 2020, with Oral Surgeons contributing to 49% of the opioid prescriptions. The antibiotic prescribing rate was 2.70% which remained steady across the years. 91% opioid and 69% antibiotic prescriptions were prescribed when the patient had at least one dental procedure associated with post-operative dental pain. Opioid prescribing had greater odds for patients between 15 to 24 years of age and dentists who were Oral Surgeons. Antibiotic prescribing had greater odds for patients more than 65 years old and dentists who were Periodontists and Implant specialists. Additionally, the odds of opioid and antibiotic prescription being made were greater when the dental visit had at least one pain-associated procedure and multiple dental procedures at the same visit. Dentists’ prescribing behavior was determined by multiple factors and was patient-centered varying from case to case. Dentists’ specialty, peer influence, faculty mentorship, complexity of dental procedure, contraindications to non-opioid analgesics and meeting patient expectations were the factors found to be influencers of dentists’ opioid prescribing behavior. Low adherence to prescribing guidelines was found with 0% complete guideline concordance for opioid prescriptions and 59% guideline discordance for antibiotic prescriptions. Conclusion: This research provided a comprehensive understanding of the factors associated with prescribing of opioid and antibiotic medications; identified trends in prescribing; and determined the extent and sources of unindicated prescriptions. The results of this research can contribute further towards the development of dental specialty specific interventions to reduce prescribing and the development of clinical decision support systems for prescribing these medications appropriately in the future.
Subject Area
Public health|Epidemiology|Dentistry
Recommended Citation
Tungare, Sayali Sunil, "Opioid and Antibiotic Prescribing in the US Academic Dental Setting" (2022). Texas Medical Center Dissertations (via ProQuest). AAI30314228.
https://digitalcommons.library.tmc.edu/dissertations/AAI30314228