Investigation of an Opioid Prescribing Protocol After Third Molar Extraction Procedures

Paul C. Tompach, Chad L. Wagner, A. Brooke Sunstrum, Robert A Nadeau, Harold K. Tu

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: The United States is experiencing an epidemic of opioid overdoses and deaths. The relation between prescription opioids and opioid abuse is well documented. Oral and maxillofacial surgeons and other dentists are proportionately among the most prevalent prescribers of opioids. Practitioners are looking for evidence-based ways to decrease excess opioid prescriptions and adequately manage postoperative pain. The authors recently analyzed the impact of a mandated nonopioid prescribing protocol at their institution. Although broad guidelines have been useful for treating postoperative pain, there are no procedure-specific guidelines for managing pain after third molar extraction. The purpose of this study was to determine whether an opioid prescribing protocol was sufficient to decrease opioid prescribing after third molar extractions. Materials and Methods: This retrospective study compared the use of opioids prescribed for patients undergoing third molar extraction before introducing and after implementing a postoperative opioid prescribing protocol. The inclusion criterion was third molar extraction performed at the Division of Oral and Maxillofacial Surgery at the University of Minnesota (Minneapolis, MN) during the fourth quarters of 2015 and 2017 with complete records. Results: The number of opioid prescriptions decreased and the number of nonopioid analgesics prescribed increased for all procedure codes after implementation of the protocol. Higher Current Dental Terminology (CDT) codes were associated with increased opioid prescriptions, indicating increased surgical difficulty was a rationale for opioid prescriptions. The mean number of opioid tablets per prescription was 15.9 in 2015 and decreased to 11.5 in 2017. No statistical difference was observed for average tablets for various CDT codes. Conclusion: Data from this study suggest an acute postoperative pain opioid prescribing protocol leads to fewer opioid prescriptions after third molar extraction procedures, less variance in opioid prescribing among practitioners, a decreased number of opioid tablets prescribed per patient, and safe and effective management of acute postoperative pain.

Original languageEnglish (US)
Pages (from-to)705-714
Number of pages10
JournalJournal of Oral and Maxillofacial Surgery
Issue number4
StatePublished - Apr 2019

Bibliographical note

Funding Information:
This research was supported by the Division of Oral and Maxillofacial Surgery at the University of Minnesota School of Dentistry (Minneapolis, Minnesota). Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.

Publisher Copyright:
© 2018 American Association of Oral and Maxillofacial Surgeons


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