There’s wisdom in toughing through the pain — people who use opioids for wisdom tooth removal are almost three times more likely to develop an opioid addiction.

Dental panoramic x-ray. Wisdom teeth are in orange. Image courtesy: IHPI.

Wisdom teeth are one of the three molars in human dentition — the most posterior of the three. They tend to erupt between the ages of 17 and 25, though that’s not always the case.  Most adults have four wisdom teeth, one in each quadrant of the mouth, but it’s possible to have more, fewer, and even none. It’s not exactly clear why this happens, but what is clear is that once they do erupt, they tend to cause a lot of pain.

Getting rid of your wisdom teeth was once regarded as a rite of passage — you would shed them during your teen years, symbolizing that you are becoming an adult, and therefore (allegedly) wiser. For most people, wisdom teeth are a pain and a half. It’s not surprising that many choose to address the teeth-induced pain with opioids. But that, researchers say, might be a very unwise decision.

These opioid painkiller prescriptions might be setting young Americans on a path to opioid addiction, a new study has shown. Young people aged 13 to 30 who filed an opioid prescription for their wisdom teeth extraction were 2.7 times more likely to be filling opioid prescriptions weeks or months later, long after the wisdom teeth issue has passed. Particularly, those in their late teens or 20s had the highest odds of persistent opioid use.

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Calista Harbaugh, a University of Michigan research fellow and surgical resident, is the lead author of the study. She wanted to assess previously-overlooked side effects associated with a benign procedure like wisdom teeth removal, especially for young people who are opioid-naïve (they haven’t been previously exposed to opioids).

“Wisdom tooth extraction is performed 3.5 million times a year in the United States, and many dentists routinely prescribe opioids in case patients need it for post-procedure pain,” says Harbaugh, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation (IHPI).

“Until now, we haven’t had data on the long-term risks of opioid use after wisdom tooth extraction. We now see that a sizable number go on to fill opioid prescriptions long after we would expect they would need for recovery, and the main predictor of persistent use is whether or not they fill that initial prescription.”

All in all, out of the 56,686 wisdom tooth patients who filled their opioid prescription between 2009 and 2015, 1.3% went on to develop a constant opioid habit, compared to 0.5% of the 14,256 who didn’t file a prescription.

Of course, this is still a correlation, and direct causality has not been established. In other words, there’s a chance that this issue is caused by an external factor. But given the scale of America’s opioid problem, it’s definitely an avenue worth investigating.

Furthermore, it seems that opioids don’t even do much good in this situation.

“There are no prescribing recommendations specifically for wisdom tooth extraction,” Harbaugh said. “With evidence that nonsteroidal anti-inflammatories may just as, if not more, effective, a seven-day opioid recommendation may still be too much.”

Romesh Nalliah, a co-author of the study and the dentist of the team, echoes this feeling. He says that dentists should reduce or stop the prescription of opioids for wisdom teeth removal. Not only will this reduce a potential cause of opioid addiction, but it can also save a lot of money.

“I believe that opioid prescribing for dental procedures can be cut to a fraction of what it is today,” he said. “Through wisdom tooth extraction, the dental profession has an enormous opportunity to fight the opioid crisis by preventing early introduction of opioids to America’s young people. We hope that our study will make my fellow dentists think twice about removing wisdom teeth, and to more strongly consider non-opioid solutions.”

America consumes more opioids than the rest of the world combined. Every day, more than 115 people in the United States die after overdosing on opioids. With roughly 1 in 4 of patients prescribed opioids for chronic pain misusing them, and around 10% of them developing an opioid addiction, any small step towards tackling this issue is more than welcome.

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The study has been published in JAMA.

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