OBJECTIVES: The objectives of this study were: (1) to determine prevalence of opioid analgesics prescribing for non-ED dental related visits in the Mississippi Medicaid population, (2) to assess predictors of receiving opioid analgesics following non-ED dental related events among Mississippi Medicaid beneficiaries, and (3) to determine prevalence of opioid analgesic prescribing for dental related emergency departments (ED) visits in the Mississippi Medicaid population.

METHODS: A retrospective, cross-sectional, observational database analysis using Mississippi Medicaid administrative claims data from January 1, 2015 to December 31, 2016. Beneficiaries with dental related visits were included in this study. Descriptive statistics were utilized to assess the prevalence of opioid prescribing for ED and non-ED dental visit events in the study period. Logistic regression analyses were conducted to assess predictors of receiving an opioid prescription following a non-ED dental related visit. Adjusted odds ratios, 95% confidence intervals and p-values were calculated for the odds of receiving an opioid analgesic and the odds of receiving an opioid analgesic with a morphine equivalent daily dose (MEDD) greater than the median value of 25.

RESULTS: A total of 16,409 dental visit events were identified and 27% of dental visit events were associated with an opioid prescription. Cleaning/preventive procedures had the lowest rate of opioid prescribing (16%) while tooth extraction procedures had the highest rate of opioid prescription (55%). Logistic regression showed that beneficiaries undergoing extraction procedures had six times higher odds to be prescribed an opioid than those undergoing cleaning/preventive procedures [OR=6.27, 95% CI: 4.64-8.46, P <0.0001]. Beneficiaries aged 18 or younger were less likely to receive an opioid in comparison to beneficiaries ages 19 to 45 years [OR=0.30, 95% CI: 0.27-0.33, P <0.0001]. Approximately 12% of opioid prescriptions for dental diseases had dosages of 50 morphine equivalents/day or higher; 53% of these prescriptions were written for more than a 3-day supply and 16% for more than a 7-day supply. Approximately 42% of dental related ED visits events were associated with an opioid prescription, and gum disease/periodontitis had the highest rate of opioid prescriptions for ED visits at 48%.

CONCLUSIONS: The findings of this study indicate that opioids are prescribed for many dental procedures. This study has a broader policy implication for the state of Mississippi regarding opioid abuse and misuse, drug utilization trend monitoring and curtailing opioid abuse by broadening the lens to the field of dentistry.