Opioids in oral surgery: preliminary findings between Birmingham, UK and Boston, US

Abstract

Aims This study aims to review ways in which UK and US practitioners manage post-operative dental pain following oral surgery procedures, focusing on the use of opioids in Boston, US and Birmingham, UK.

Methods An anonymous online questionnaire was distributed to clinicians from either Birmingham Dental Hospital, UK and Harvard School of Dental Medicine or Boston University School of Dental Medicine, US. They were invited to fill this out via email link or in person using a tablet provided. Information was collected regarding age, years of experience, area of practice, area of undergraduate training, gender and levels of oral surgery activity. Participants were presented with six clinical scenarios and asked to indicate how they would achieve post-operative analgesia for each.

Results A total of 44 responses were received, 22 from each city, including 27 males and 17 females. Fifty-five percent of respondents carried out at least ten weekly oral surgery procedures, with 52% having more than ten years' experience. Forty-one percent were aged greater than 40 years, with 32% less than 30. Boston dentists were 2.1 times (P = 0.016) more likely to opt for opioids than Birmingham dentists. Both cohorts were more likely to choose opioids for invasive surgeries involving flap procedures compared to simple extractions. Among the cases where UK respondents opted for opioids, codeine was chosen in 100% of cases compared to 9% for the US cohort, where the remainder chose more potent opioids (oxycodone, hydrocodone and tramadol).

Conclusions Results of this preliminary study show that Boston practitioners were likely to opt for opioids in a higher proportion of cases (19.84%) than Birmingham practitioners (9.42%). Reasons for the discrepancies could be related to how practitioners are trained, patient expectations on pain relief and health policy in the two countries. Dental prescriptions have contributed to the US opioid epidemic and their decreased use will be important in combatting the crisis.

Key points

• Provides an insight into some of the current prescribing practices carried out following oral surgery procedures by Birmingham (UK) practitioners compared to Boston (US) practitioners.

• Provides preliminary details into the different nature of opioids prescribed by practitioners in the two countries and reasons as to why they may differ.

• Highlights different types of opioids that can be used in dentistry in other parts of the world and the multiple ways to achieve analgesia which may differ from common UK practices.

• The reader gains knowledge about the opioid epidemic in the US and the role dentistry has to play in this as well as some of the ways dentists may be unknowingly contributing to the crisis.