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Comment & Response
December 11, 2018

Third Molar Extraction and Persistent Use of Opioids—Reply

Author Affiliations
  • 1Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
  • 2University of Michigan Medical School, Ann Arbor
  • 3University of Michigan School of Dentistry, Ann Arbor
JAMA. 2018;320(22):2377-2378. doi:10.1001/jama.2018.17203

In Reply Dr Ferguson and colleagues raised concerns about our study demonstrating an association between perioperative opioid prescribing and new persistent opioid use in opioid-naive adolescents and young adults undergoing third molar (wisdom tooth) extraction.1

In response, we wish to clarify the exposure and the outcome of interest in the analysis. First, the exposure was limited to any opioid prescription from 7 days before to 3 days after third molar extraction. This definition was used to test the association of routine opioid prescribing with persistent opioid use. Although prescriptions beyond 3 days may have a perioperative indication for delayed pain secondary to infection or complication, they remain unlikely to represent the routine provision of a perioperative prescription.