Although nonsteroidal anti inflammatory drugs are superior to opioids in dental pain management, opioids are still prescribed for dental pain in the United States. Little is known about the serious adverse outcomes of short-acting opioids within the context of dental prescribing. The objective of this study was to evaluate adverse outcomes and persistent opioid use (POU) after opioid prescriptions by dentists, based on whether opioids were overprescribed or within recommendations. A cross-sectional analysis of adults with a dental visit and corresponding opioid prescription (index) from 2011 to 2018 within a nationwide commercial claims database was conducted. Opioid overprescribing was defined as >120 morphine milligram equivalents per Centers for Disease Control and Prevention guidelines. Generalized estimating equation models were used to assess adverse outcomes (emergency department visits, hospitalizations, newly diagnosed substance use disorder, naloxone administration, or death within 30 days from index) and POU (≥1 prescription 4-90 days postindex). Predicted probabilities are reported. Of 633,387 visits, 2.6% experienced an adverse outcome and 16.6% had POU. Adverse outcome risk was not different whether opioids were overprescribed or within recommendations (predicted probability 9.0%, confidence interval [CI]: 8.0%-10.2% vs 9.1%, CI: 8.1-10.3), but POU was higher when opioids were overprescribed (predicted probability 27.4%, CI: 26.1%-28.8% vs 25.2%, CI: 24.0%-26.5%). Visits associated with mild pain and those with substance use disorders had the highest risk of both outcomes. Findings from this study demonstrate that dental prescribing of opioids was associated with adverse outcomes and POU, even when prescriptions were concordant with guidelines. Additional efforts are required to improve analgesic prescribing in dentistry, especially in groups at high risk of opioid-related adverse outcomes.

尽管非甾体类抗炎药在治疗牙痛方面优于阿片类药物，但在美国，阿片类药物仍用于治疗牙痛。对于牙科处方中短效阿片类药物的严重不良后果知之甚少。本研究的目的是根据阿片类药物是否过量或在建议范围内，评估牙医开出阿片类药物处方后的不良后果和持续使用阿片类药物 (POU)。在全国商业索赔数据库中，对 2011 年至 2018 年进行过牙科检查和相应阿片类药物处方（指数）的成年人进行了横断面分析。根据疾病控制和预防中心指南，阿片类药物过量处方被定义为> 120 吗啡毫克当量。使用广义估计方程模型来评估不良结局（急诊科就诊、住院、新诊断的物质使用障碍、纳洛酮给药或指数后 30 天内死亡）和 POU（指数后 4-90 天≥1 处方）。报告预测概率。在 633,387 次就诊中，2.6% 出现不良结果，16.6% 出现 POU。无论阿片类药物过量使用还是在建议范围内，不良结果风险均无差异（预测概率 9.0%，置信区间 [CI]：8.0%-10.2% vs 9.1%，CI：8.1-10.3），但阿片类药物过量使用时，POU 较高（预测概率 27.4%，CI：26.1%-28.8% vs 25.2%，CI：24.0%-26.5%）。与轻度疼痛相关的就诊和患有药物滥用障碍的就诊，两种结果的风险最高。这项研究的结果表明，阿片类药物的牙科处方与不良后果和 POU 相关，即使处方与指南一致。需要付出更多努力来改善牙科镇痛处方，特别是在阿片类药物相关不良后果高风险群体中。