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Association of sociodemographic factors with the prescription pattern of opioids for dental patients: a systematic review


Aim To evaluate the association of patients' sociodemographic factors (sex, age, ethnicity, income, educational level, living environment and health insurance) with the prescription pattern of opioids provided by oral health practitioners.

Methods Observational studies that evaluated the association of patients' sociodemographic factors and the likelihood of receiving an opioid prescription provided by an oral health practitioner were eligible. Electronic searches were conducted in Medline (PubMed), Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar, and OpenGrey up to March 2021. Two authors independently screened the studies, performed data extraction, and assessed the risk-of-bias using the critical appraisal tools developed by the Joanna Briggs Institute (JBI). Certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results Eight studies were included in this systematic review. Publication year ranged from 2011 to 2021. Narrative synthesis showed with very low certainty of evidence that younger individuals were more likely to receive a prescription of opioids than older individuals. Regarding the other sociodemographic factors and the prescriptions of opioids in dentistry, the evidence is controversial. Risk of bias was low for most items assessed in the included studies.

Conclusion The available evidence suggests that there is an association between patients' sociodemographic factors and the prescription patterns of opioids provided by oral health practitioners.

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  1. Kunnumpurath S, Julien N, Kodumudi G, Kunnumpurath A, Kodumudi V, Vadivelu N. Global supply and demand of opioids for pain management. Curr Pain Headache Rep 2018; DOI: 10.1007/s11916-018-0689-1.

  2. Benyamin R, Trescot A M, Datta S et al. Opioid complications and side effects. Pain Physician 2008; 11(2 Suppl): S105-S120.

  3. Colvin L A, Bull F, Hales T G. Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia. Lancet 2019; 393: 1558-1568.

  4. Jeffrey Kao M C, Minh L C, Huang G Y, Mitra R, Smuck M. Trends in ambulatory physician opioid prescription in the United States, 1997-2009. PM R 2014; DOI: 10.1016/j.pmrj.2013.12.01.

  5. Bedene A, Lijfering W M, Niesters M et al. Opioid prescription patterns and risk factors associated with opioid use in the Netherlands. JAMA Netw Open 2019; DOI: 10.1001/jamanetworkopen.2019.10223.

  6. Goodman-Meza D, Friedman J, Kalmin M M et al. Geographical and socioeconomic disparities in opioid access in Mexico, 2015-19: a retrospective analysis of surveillance data. Lancet Public Health 2021; DOI: 10.1016/S2468-2667(20)30260-7.

  7. Volkow N D, Frieden T R, Hyde P S, Cha S S. Medication-assisted therapies - tackling the opioid-overdose epidemic. N Engl J Med 2014; 370: 2063-2066.

  8. Belzak L, Halverson J. The opioid crisis in Canada: a national perspective. Health Promot Chronic Dis Prev Can 2018; 38: 224-233.

  9. Moore P A, Ziegler K M, Lipman R D, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. J Am Dent Assoc 2018; 149: 256-265.

  10. Nalliah R P, Sloss K R, Kenney B C et al. Association of opioid use with pain and satisfaction after dental extraction. JAMA Netw Open 2020; DOI: 10.1001/jamanetworkopen.2020.0901.

  11. Levy B, Paulozzi L, Mack K A, Jones C M. Trends in opioid analgesic-prescribing rates by speciality U S., 2007-2012. Am J Prev Med 2015; 49: 409-413.

  12. Adewumi A D, Maravilla J C, Alati R et al. Pharmaceutical opioids utilisation by dose, formulation, and socioeconomic status in Queensland, Australia: a population study over 22 years. Int J Clin Pharm 2021; 43: 328-339.

  13. Moeller J, Farmer J, Quinonez C. Patterns of analgesic use to relieve tooth pain among residents in British Columbia, Canada. PLoS One 2017; DOI: 10.1371/journal.pone.0176125.

  14. Lino P A, Sohn W, Singhal A, Martins M A P, Silva M, Abreu M. A national study on the use of opioid analgesics in dentistry. Braz Oral Res 2019; DOI: 10.1590/1807-3107bor-2019.vol33.0076.

  15. Constante H M, Bastos J L, Peres K G, Peres M A. Socio-demographic and behavioural inequalities in the impact of dental pain among adults: a population-based study. Community Dent Oral Epidemiol 2012; 40: 498-506.

  16. Cadoret C A, Garcia R I. Health disparities and the multicultural imperative. J Evid Based Dent Pract 2014; DOI: 10.1016/j.jebdp.2014.02.003.

  17. Adewumi A D, Maravilla J C, Alati R et al. Duration of opioid use and association with socioeconomic status, daily dose and formulation: a two-decade population study in Queensland, Australia. Int J Clin Pharm 2021; 43: 340-350.

  18. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep 2018; 67: 1419-1427.

  19. Moride Y, Lemieux-Uresandi D, Castillon G et al. A systematic review of interventions and programs targeting appropriate prescribing of opioids. Pain Physician 2019; 22: 229-240.

  20. Page M J, McKenzie J E, Bossuyt P M et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med 2021; DOI: 10.1371/journal.pmed.1003583.

  21. Haddaway N R, Collins A M, Coughlin D, Kirk S. The role of Google Scholar in evidence reviews and its applicability to grey literature searching. PLoS One 2015; DOI: 10.1371/journal.pone.0138237.

  22. Moola S, Munn Z, Tufanaru C et al. Systematic reviews of aetiology and risk. In Aromataris E M Z (ed) JBI manual for evidence synthesis. Australia: JBI, 2020.

  23. Guyatt G H, Oxman A D, Vist G E et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926.

  24. Barasch A, Safford M M, McNeal S F, Robinson M, Grant V S, Gilbert G H. Patterns of postoperative pain medication prescribing after invasive dental procedures. Spec Care Dentist 2011; 31: 53-57.

  25. Steinmetz C N, Zheng C, Okunseri E, Szabo A, Okunseri C. Opioid analgesic prescribing practices of dental professionals in the United States. JDR Clin Trans Res 2017; 2: 241-248.

  26. Janakiram C, Chalmers N I, Fontelo P et al. Sex and race or ethnicity disparities in opioid prescriptions for dental diagnoses among patients receiving Medicaid. J Am Dent Assoc 2019; 150: DOI: 10.1016/j.adaj.2019.06.016.

  27. Obadan-Udoh E, Lupulescu-Mann N, Charlesworth C J et al. Opioid prescribing patterns after dental visits among beneficiaries of Medicaid in Washington state in 2014 and 2015. J Am Dent Assoc 2019; DOI: 10.1016/j.adaj.2018.12.030.

  28. Priest C R, Kenney B C, Brummett C M, Waljee J F, Englesbe M J, Nalliah R P. Increased opioid prescription fills after dental procedures performed before weekends and holidays. J Am Dent Assoc 2020; DOI: 10.1016/j.adaj.2020.03.014.

  29. Miller C S, Ke C, Witty J T, Nagarajan R. Prescribing patterns of opioid analgesics in a dental setting: 2013-2018. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130: 402-410.

  30. Ringwalt C, Roberts A W, Gugelmann H, Skinner A C. Racial disparities across provider specialties in opioid prescriptions dispensed to medicaid beneficiaries with chronic noncancer pain. Pain Med 2015; 16: 633-640.

  31. Richard P, Bauer M R, Moresco N et al. Opioid prescribing for surgical dental procedures in dental clinics of military treatment facilities. J Am Dent Assoc 2021; DOI: 10.1016/j.adaj.2020.09.020.

  32. Serdarevic M, Striley C W, Cottler L B. Sex differences in prescription opioid use. Curr Opin Psychiatry 2017; 30: 238-246.

  33. Williams R E, Sampson T J, Kalilani L, Wurzelmann J I, Janning S W. Epidemiology of opioid pharmacy claims in the United States. J Opioid Manag 2008; 4: 145-152.

  34. Serdarevic M, Striley C W, Gurka K K, Leeman R F, Cottler L B. Sex differences in prescription opioid use patterns assessed through a community engagement programme in Florida. Drug Alcohol Depend 2019; 204: 107, 568.

  35. Schieber L Z, Guy G P Jr, Seth P, Losby J L. Variation in adult outpatient opioid prescription dispensing by age and sex - United States, 2008-2018. MMWR Morb Mortal Wkly Rep 2020; 69: 298-302.

  36. Fillingim R B, King C D, Ribeiro-Dasilva M C, Rahim-Williams B, Riley III J L. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009; 10: 447-485.

  37. Lutfiyya M N, Gross A J, Soffe B, Lipsky M S. Dental care utilization: examining the associations between health services deficits and not having a dental visit in past 12 months. BMC Public Health 2019; DOI: 10.1186/s12889-019-6590-y.

  38. Australian Research Centre for Population Oral Health. Dental visiting and use of dental services among the Australian older population. Aust Dent J 2010; 55: 223-227.

  39. Volkow N D, McLellan T A, Cotto J H, Karithanom M, Weiss S R. Characteristics of opioid prescriptions in 2009. JAMA 2011; 305: 1299-1301.

  40. Schroeder A R, Dehghan M, Newman T B, Bentley J P, Park K T. Association of opioid prescriptions from dental clinicians for US adolescents and young adults with subsequent opioid use and abuse. JAMA Intern Med 2019; 179: 145-152.

  41. Zosel A, Bartelson B B, Bailey E, Lowenstein S, Dart R. Characterization of adolescent prescription drug abuse and misuse using the Researched Abuse Diversion and Addiction-related Surveillance (RADARS) system. J Am Acad Child Adolesc Psychiatry 2013; DOI: 10.1016/j.jaac.2012.11.014.

  42. Hudgins J D, Porter J J, Monuteaux M C, Bourgeois F T. Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Med 2019; DOI: 10.1371/journal.pmed.1002922.

  43. Page M G, Kudrina I, Zomahoun H T V et al. A systematic review of the relative frequency and risk factors for prolonged opioid prescription following surgery and trauma among adults. Ann Surg 2020; 271: 845-854.

  44. Bailey Z D, Krieger N, Agenor M, Graves J, Linos N, Bassett M T. Structural racism and health inequities in the USA: evidence and interventions. Lancet 2017; 389: 1453-1463.

  45. Alhusen J L, Bower K M, Epstein E, Sharps P. Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. J Midwifery Womens Health 2016; 61: 707-720.

  46. Coker T R, Elliott M N, Toomey S L et al. Racial and ethnic disparities in ADHD diagnosis and treatment. Paediatrics 2016; doi: 10.1542/peds.2016-0407.

  47. Freeman H P, Payne R. Racial injustice in health care. N Engl J Med 2000; 342: 1045-1047.

  48. Santoro T N, Santoro J D. Racial bias in the US opioid epidemic: a review of the history of systemic bias and implications for care. Cureus 2018; DOI: 10.7759/cureus.3733.

  49. Hall W J, Chapman M V, Lee K M et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health 2015; DOI: 10.2105/AJPH.2015.302903.

  50. Hoffman K M, Trawalter S, Axt J R, Oliver M N. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A 2016; 113: 4296-4301

  51. White-Davis T, Edgoose J, Brown Speights J S et al. Addressing racism in medical education an interactive training module. Fam Med 2018; 50: 364-368.

  52. Marcelin J R, Siraj D S, Victor R, Kotadia S, Maldonado Y A. The impact of unconscious bias in healthcare: how to recognize and mitigate it. J Infect Dis 2019; 220(220 Suppl 2): S62-S73.

  53. Hassen N, Lofters A, Michael S, Mall A, Pinto A D, Rackal J. Implementing anti-racism interventions in healthcare settings: a scoping review. Int J Environ Res Public Health 2021; DOI: 10.3390/ijerph18062993.

  54. Peres M A, Macpherson L M D, Weyant R J et al. Oral diseases: a global public health challenge. Lancet 2019; 394: 249-260.

  55. Pajewski N M, Okunseri C. Patterns of dental service utilization following nontraumatic dental condition visits to the emergency department in Wisconsin Medicaid. J Public Health Dent 2014; 74: 34-41.

  56. Lee H H, Lewis C W, Saltzman B, Starks H. Visiting the emergency department for dental problems: trends in utilization, 2001 to 2008. Am J Public Health 2012; DOI: 10.2105/AJPH.2012.300965.

  57. Anderson L, Cherala S, Traore E, Martin N R. Utilization of hospital emergency departments for non-traumatic dental care in New Hampshire, 2001-2008. J Community Health 2011; 36: 513-516.

  58. Rampa S, Wilson F A, Wani R, Allareddy V. Emergency department utilization related to dental conditions and distribution of dentists, Nebraska 2011-2013. J Evid Based Dent Pract 2017; 17: 83-91.

  59. Quinonez C, Gibson D, Jokovic A, Locker D. Emergency department visits for dental care of nontraumatic origin. Community Dent Oral Epidemiol 2009; 37: 366-371.

  60. Roberts R M, Bohm M K, Bartoces M G, Fleming-Dutra K E, Hicks L A, Chalmers N I. Antibiotic and opioid prescribing for dental-related conditions in emergency departments: United States, 2012 through 2014. J Am Dent Assoc 2020; DOI: 10.1016/j.adaj.2019.11.013.

  61. Hafner M B, Zanatta J, Rasera Zotelli V L, Batista M J, Sousa Mda L. Perception of toothache in adults from state capitals and interior cities within the Brazilian geographic regions. BMC Oral Health 2013; DOI: 10.1186/1472-6831-13-35.

  62. Ostrom C, Bair E, Maixner W et al. Demographic predictors of pain sensitivity: results from the OPPERA Study. J Pain 2017; 18: 295-307.

  63. American Dental Association. Statement on the use of opioids in the treatment of dental pain. 2016. Available at: (accessed July 2022).

  64. McCauley J L, Leite R S, Melvin C L, Fillingim R B, Brady K T. Dental opioid prescribing practices and risk mitigation strategy implementation: Identification of potential targets for provider-level intervention. Subst Abus 2016; 37: 9-14.

  65. Hollingworth S A, Chan R, Pham J, Shi S, Ford P J. Prescribing patterns of analgesics and other medicines by dental practitioners in Australia from 2001 to 2012. Community Dent Oral Epidemiol 2017; 45: 303-309.

  66. Teoh L, Stewart K, Marino R J, McCullough M J. Part 2. Current prescribing trends of dental non-antibacterial medicines in Australia from 2013 to 2016. Aust Dent J 2018; DOI: 10.1111/adj.12613.

  67. Suda K J, Durkin M J, Calip G S et al. Comparison of opioid prescribing by dentists in the United States and England. JAMA Netw Open 2019; DOI: 10.1001/jamanetworkopen.2019.4303.

  68. Ticku S, Starr J R, Da Silva J D, Elani H W. Prescribing patterns in a US dental school from 2010 to 2017. J Dent Educ 2020; 84: 660-668.

  69. Langan S M, Schmidt S A, Wing K et al. The reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE). BMJ 2018; DOI: 10.1136/bmj.k3532.

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Data availability statement: the data that support the findings of this study are available from the corresponding author upon reasonable request. The authors ensure that no previously published illustrations were used in this study.


Mauro Henrique Nogueira Guimarães de Abreu is fellow research at the National Research Council (Conselho Nacional de Pesquisa [CNPq]). Fellowship nº: 303772/2019-0. Lucas Guimarães Abreu is fellow research at the National Research Council (Conselho Nacional de Pesquisa [CNPq]). Fellowship nº: 310797/2019-5. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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AJSC worked on the study conceptualisation, design, development of the search strategy, search and selection of studies to be included in the review. AJSC also worked on the extraction of quantitative and qualitative data, risk of bias assessment, interpretation of the data, drafting of the manuscript, and approval of the final version of the manuscript as submitted. LGA worked on study conceptualisation, design, development of the search strategy, data analysis, critically review of the manuscript, and approval of the final version of the manuscript as submitted. SRM worked on selection of studies to be included in the review and in the approval of the final version of the manuscript as submitted. LSC worked on study conceptualisation, critical review of the manuscript, and approval of the final version of the manuscript as submitted. MHNGA worked on study conceptualisation, design, extraction and management of quantitative and qualitative data, risk of bias assessment, interpretation of the data, critical review of the manuscript, and approval of the final version of the manuscript as submitted.

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Correspondence to Alex Junio Silva Cruz.

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Cruz, A., Abreu, L., da Rocha Mendes, S. et al. Association of sociodemographic factors with the prescription pattern of opioids for dental patients: a systematic review. Evid Based Dent (2022).

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