By Anne Blythe

For some college students, the winter break can be a time for visiting doctors and dentists back home.

Annual physicals, routine dental cleanings or even the extraction of wisdom teeth might be on the calendar.

Teens and young adults who suffered through one of the more excruciating inductions into adulthood  — having their wisdom teeth pulled — might be sent home with a prescription for painkillers.

That can be an introduction to opioids, addictive compounds that contribute to the rising number of drug overdose deaths in North Carolina and nationally.

In 2021, the most recent year for which data are available, more than 3,900 North Carolinians died from drug overdoses, according to the state Department of Health and Human Services. That was a 26 percent increase compared with such fatalities in 2020.

As substance use disorders become more prevalent, the increased presence of the powerful synthetic opioid fentanyl in illicit markets has led to contaminated street drugs and counterfeit pills that are extremely dangerous.

As part of a multi-pronged public health effort to attack the opioid crisis destroying the lives of so many, the state Department of Health and Human Services recently released an updated three-year NC Dental Opioid Action Plan.

Schematic of the focus areas of the state’s opioid action plan that includes dentists. Credit: NC Department of Health and Human Services

The goal is to provide dentists, their patients, staff, families and others with steps they can take to become part of the solution.

“Many people’s first contact with opioids happens when they are prescribed as pain relief after common dental procedures like wisdom tooth removal,” Mark Benton, a DHHS deputy secretary for health, said in a statement when the plan was released in late 2022. “This plan supports the state’s dental providers with actionable steps to both prescribe opioids judiciously and connect their patients to community resources. It’s an integral piece of the department’s work to combat the opioid epidemic.”

The oral health plan is aligned with the state’s broader Opioid and Substance Abuse Action Plan, according to DHHS.

Representatives from the North Carolina Dental Society, specialty dentists and others were instrumental in developing the new goals and policies.

Their recommendations stem from a call to action that state Attorney General Josh Stein and dentists issued in 2019, months before the COVID-19 pandemic took root and overshadowed other public health issues.

The plan includes steps such as prescribing fewer opioids for young people having a “third molar extraction,” namely, having their wisdom teeth out, and offering training at all dental, dental hygiene and dental assistant schools on better pain management techniques.

It encourages “coordination with pain specialists” when prescribing treatment with opioids for patients who have chronic pain in their face, jaw or mouth.

What the ADA says

They have been building upon statements issued on opioids in 2016 and 2018 by the American Dental Association.

The national organization recommends:

The North Carolina plan not only includes the ADA recommendations, it also focuses on what patients and families can do with leftover prescribed opioids. Unused pills stored in medicine cabinets can end up in the wrong hands when they should instead be disposed of through monitored plans that track opioids.

The plan includes a proposal to establish an opioid research agenda, through which North Carolina dental schools and researchers can better inform the state about the impact of the drugs.

Stein commended DHHS and the North Carolina Dental Society for continuing efforts to lower the use of opioids after dental visits, during a recent phone interview with NC Health News.

Prescribe more than British counterparts

A study published in JAMA in 2019 shows that American dentists were among the top prescribers of opioids, second only to family physicians. Compared with their counterparts in England, U.S. dentists were 37 percent more likely to write prescriptions for opioids.

“So much of dental pain has to do with inflammation,” Stein said during his interview. 

If prescribers shifted their focus to the cause of the pain — the inflammation — that might result in a lower reliance on opioids.

Stein, who made opioid reduction a focus of his first term, said he was glad to see the oral health community and state public health workers look for new therapeutic methods to help dental patients after painful procedures.

“There is more work to be done,” Stein said. “A lot of patient education needs to happen.”

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Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.

Join the Conversation

7 Comments

  1. Pain is mot pleasant,why so much conversation over a few pills that offer,at times much needed relief? The so called opoid crisis seems to be a weak minded crisis. There is a time and place for everything.

  2. What a joke its not inflammation they ripped your teeth out and nothing helps but opiates and they no it they rely on ignorence to push thus garbage ..and dont you dare complain or your a junkie …discusting..

  3. This has become frustrating to me because the main issue is street Fentanyl ! That’s mainly where overdoses and deaths are coming from. There are too many people in pain. People with legit problems that’s tried ADVIL.Whatever kind of Toothache can be excruciating pain.Government as gone too far in my opinion. Too many people having to live there life in pain.Many are taking their lives because of it. Enough is enough!

  4. Rarely do people become addicted because of a 3-5 day supply of opioids for dental pain. There are many studies that prove addiction is not huge after opioids are given for dental procedures. One study says about 8% were still taking at 3 months out. And no context about those patients that were, like possibly ongoing dental work. And parents usually keep a sharp eye on any prescription opioids a teen gets. To do otherwise would be negligent. So why the eagle eye on dental work? The focus should be on good doctor/patient relationship and street drugs. Opioids do not cause addiction if taken as directed and stopping them as pain subsides. Surgeons have known this for a long time. Do you also think surgeons have made addicts? Nobody makes an addict, no drug, all people are different as to what the can and do use recreationally. This is out of the doctors and dentists hands. One script for dental will not addict. This making people suffer because of the fear of dentists and doctors prescribing needs to stop! The deadly drugs are in the streets and the bodies are piling up. Street drugs addict much quickly and many start there. Get on the right side of this issue or the deaths will continue to rise.

  5. This can swing too far the other way. I ‘m 72 and was recently denied pain pills after tooth surgery, by my insurance. I told the pharmacy, ” I only want 3 pills, not 30!” Thank God, I finally got them.

  6. I speak and write widely on public policy for regulation of prescription opioids and clinicians who employ them in pain management. I have published over 150 papers, articles and interviews on the subject, under peer review and sometimes with clinician co-authors. From this background I must assert that the supposed dangers of medically managed opioids are vastly over-hyped. In reality, “Physicians Prescribing To Their Patients Did Not Create the US Opioid Crisis” And denying effective pain relief won’t solve the crisis.

    Here is what Dr Nora Volkow, Director of the National Institute on Drug Abuse had to say on the subject in 2016:

    “Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with pre-existing vulnerabilities…Older medical texts and several versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) either overemphasized the role of tolerance and physical dependence in the definition of addiction or equated these processes (DSM-III and DSM-IV). However, more recent studies have shown that the molecular mechanisms underlying addiction are distinct from those responsible for tolerance and physical dependence, in that they evolve much more slowly, last much longer, and disrupt multiple brain processes.”

    Citation: Nora D Volkow, MD, and Thomas A McLellan, Ph.D., “Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies” . NEMJ 2016; 374:1253-1263 March 31, 2016].

    Come talk to me, Anne. You are preaching a discredited mythology.

    1. This comment has been edited to remove urls, in keeping with NC Health News’ comments policy.

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