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Comment & Response
May 20, 2019

Dangers of Opioid Prescribing for Young Adults After Dental Procedures

Author Affiliations
  • 1Department of Oral and Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia
  • 2Dental Anesthesiology Residency Program, Jacobi Medical Center, Bronx, New York
  • 3Department of Dental Anesthesiology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Intern Med. 2019;179(7):997-998. doi:10.1001/jamainternmed.2019.0185

To the Editor The important Original Investigation by Schroeder and colleagues1 that was recently published in JAMA Internal Medicine demonstrates the potential dangers of prescribing immediate-release opioids to a vulnerable population of adolescents and young adults. There are a few facts concerning the surgical removal of third molars that we would like to highlight. The authors state that these teeth normally erupt between the ages of 16 to 25 years. However, the teeth being targeted for surgery are usually impacted and only partially erupted or fully embedded in bone below the soft tissue. The trauma associated with their surgical removal consistently produces moderate to severe pain—the reason the US Food and Drug Administration considers it a pivotal acute pain model in analgesic approval.2 We were surprised that only 2.4% of first prescribers were classified as general surgeons or oral and maxillofacial specialists. Oral surgeons, who have 3 or 4 years of postdoctoral hospital-based training, possess doctor of dental medicine or doctor of dental surgery degrees, as do general dentists, so exactly who the first prescribers were was somewhat confusing. Others have reported that 60% of immediate-release opioid prescriptions are written by oral surgeons.3

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