BACKGROUND: Variation in opioid prescribing rates among geographic regions is well known and, to the authors' knowledge, there have been no studies of variation from 1 dental clinic to another, and such variation might suggest an excess of opioid prescriptions. METHODS: The authors used a retrospective cohort design study of all dental encounter records for 819,453 soldiers in the dental clinics (n = 250) of the US Military Health System during the period from 2008 through 2017. RESULTS: There were 743,459 dental surgical encounters. Opioid prescriptions were filled for 36.7% of these encounters. Multinomial multilevel regression found statistically significant between-facility variance in opioid prescribing, which was partially explained via facility-level characteristics (region, type, and percentage of surgeries for young patients), and practice variables (mean percentage extractions, percentage periodontic surgery, and percentage specialists). CONCLUSIONS: The authors found a substantial variation in opioid prescribing among dental clinics in the US Military Health System. Dentists at 11 of the 30 largest military treatment facilities prescribed at a rate 4 percentage points higher than expected, and dentists at 9 of these military treatment facilities had a rate of 4 percentage points lower than expected. Additional study of the factors allowing the low-prescribing facilities to achieve these rates might lead to an overall decrease in opioid prescribing. PRACTICAL IMPLICATIONS: The authors' findings of dental opioid prescribing in the military can lead to appreciation of the guidelines from the American Dental Association and the American Association of Oral and Maxillofacial Surgeons, which suggest alternatives to opioid prescribing for surgical procedures, particularly for tooth extractions.
BACKGROUND: Variation in opioid prescribing rates among geographic regions is well known and, to the authors' knowledge, there have been no studies of variation from 1 dental clinic to another, and such variation might suggest an excess of opioid prescriptions. METHODS: The authors used a retrospective cohort design study of all dental encounter records for 819,453 soldiers in the dental clinics (n = 250) of the US Military Health System during the period from 2008 through 2017. RESULTS: There were 743,459 dental surgical encounters. Opioid prescriptions were filled for 36.7% of these encounters. Multinomial multilevel regression found statistically significant between-facility variance in opioid prescribing, which was partially explained via facility-level characteristics (region, type, and percentage of surgeries for young patients), and practice variables (mean percentage extractions, percentage periodontic surgery, and percentage specialists). CONCLUSIONS: The authors found a substantial variation in opioid prescribing among dental clinics in the US Military Health System. Dentists at 11 of the 30 largest military treatment facilities prescribed at a rate 4 percentage points higher than expected, and dentists at 9 of these military treatment facilities had a rate of 4 percentage points lower than expected. Additional study of the factors allowing the low-prescribing facilities to achieve these rates might lead to an overall decrease in opioid prescribing. PRACTICAL IMPLICATIONS: The authors' findings of dental opioid prescribing in the military can lead to appreciation of the guidelines from the American Dental Association and the American Association of Oral and Maxillofacial Surgeons, which suggest alternatives to opioid prescribing for surgical procedures, particularly for tooth extractions.
Authors: Jason W Busse; Li Wang; Mostafa Kamaleldin; Samantha Craigie; John J Riva; Luis Montoya; Sohail M Mulla; Luciane C Lopes; Nicole Vogel; Eric Chen; Karin Kirmayr; Kyle De Oliveira; Lori Olivieri; Alka Kaushal; Luis E Chaparro; Inna Oyberman; Arnav Agarwal; Rachel Couban; Ludwig Tsoi; Tommy Lam; Per Olav Vandvik; Sandy Hsu; Malgorzata M Bala; Stefan Schandelmaier; Anne Scheidecker; Shanil Ebrahim; Vahid Ashoorion; Yasir Rehman; Patrick J Hong; Stephanie Ross; Bradley C Johnston; Regina Kunz; Xin Sun; Norman Buckley; Daniel I Sessler; Gordon H Guyatt Journal: JAMA Date: 2018-12-18 Impact factor: 56.272
Authors: Richard A Deyo; Sara E Hallvik; Christi Hildebran; Miguel Marino; Eve Dexter; Jessica M Irvine; Nicole O'Kane; Joshua Van Otterloo; Dagan A Wright; Gillian Leichtling; Lisa M Millet Journal: J Gen Intern Med Date: 2016-08-02 Impact factor: 5.128
Authors: Jenna L McCauley; Renata S Leite; Valeria V Gordan; Roger B Fillingim; Gregg H Gilbert; Cyril Meyerowitz; David Cochran; D Brad Rindal; Kathleen T Brady Journal: J Am Dent Assoc Date: 2018-03-15 Impact factor: 3.634
Authors: Brandon C Maughan; Elliot V Hersh; Frances S Shofer; Kathryn J Wanner; Elizabeth Archer; Lee R Carrasco; Karin V Rhodes Journal: Drug Alcohol Depend Date: 2016-09-20 Impact factor: 4.492
Authors: Gery P Guy; Kun Zhang; Michele K Bohm; Jan Losby; Brian Lewis; Randall Young; Louise B Murphy; Deborah Dowell Journal: MMWR Morb Mortal Wkly Rep Date: 2017-07-07 Impact factor: 17.586