Highlights
1. 3.6% of toothache diagnoses resulted in opioid prescriptions, with significant state-level variability.
2. Virginia, Georgia, and Maryland had the highest prescribing rates, while South Dakota, Hawaii, and California had the lowest.
3. Rural areas showed slightly lower opioid prescribing rates compared to urban areas (PR = 0.89).
Background
Toothache is a common dental complaint that often leads to pain medication prescriptions. While opioids can be effective for acute pain management, their use for dental pain has been linked to increased risks of misuse and addiction. Understanding prescribing patterns is crucial for developing targeted interventions to promote safer pain management practices.
Study Design
This cross-sectional analysis utilized the Epic Cosmos electronic health record database, covering patients in all US states except Alaska from August 2020 to July 2024. The study measured the prevalence of opioid prescriptions issued within 3 days of a toothache diagnosis, comparing state-level rates to the national average and examining urban-rural differences using Rural-Urban Commuting Area codes.
Key Findings
Among 1,382,711 toothache diagnoses, 49,190 (3.6%) resulted in opioid prescriptions. Significant geographic variation was observed:
1.
State-Level Differences
Fifteen states exceeded the national average in opioid prescribing, with Virginia showing the highest rate (PR = 2.31). Conversely, 27 states had below-average prescribing, with South Dakota exhibiting the lowest rate (PR = 0.20).
2.
Urban-Rural Disparities
Rural areas demonstrated slightly lower opioid prescribing rates compared to urban areas (PR = 0.89).
Expert Commentary
These findings highlight the need for standardized prescribing guidelines for dental pain management. The significant state-level variations suggest that factors beyond clinical need, such as regional prescribing culture or regulatory environments, may influence opioid prescription patterns. The slightly lower rates in rural areas may reflect differences in access to dental care or alternative pain management strategies.
Conclusion
This study reveals substantial geographic variation in opioid prescribing for toothache pain across the United States. These findings can inform targeted interventions to promote evidence-based pain management and reduce unnecessary opioid exposure. Future research should examine the underlying factors driving these disparities to develop more effective regulatory and educational approaches.
