510% increase in oxycodone scripts from dentists


dentist's hands with implements

Prescribing by dentists is on the increase – particularly for antibiotics, opioids and benzodiazepines – but why are they prescribing more?

University of Western Australia PhD scholar Dr Alex Park has examined changes in prescribing by dentists between 2006 and 2018, and says several factors could be involved in the upward trend in the number of medications prescribed by dentists.

“Over-prescription of medicines is definitely something that needs exploring,” Dr Park says.

The most likely factor is simply an increase in the number of dentists practising and the general increase in population, he says.

“It may also be attributed to an increase in the scope of dentists and their ability to use medicine for a variety of purposes to treat patients,” he said.

“From 2006 to 2018, the number of general dentists in Australia increased by 70% (10,400 to 17,720), and dental specialist numbers increased by 39% (1,300 to 1,805).”

Dr Park said prescribing medication is an important part of dentistry to relieve pain and prevent spreading of infection.

“But just like the work of a surgeon, the balances of medications are complex, and if not exact, can have significant impacts on patient care.

“Out of the 56 medications used in dentistry, 20 medicines account for 97.4% of the total dispensing count and 11 out of 20 medicines, the study noted, were antibiotics.

“Overall, increases were observed for seven out of 20 medicines (amoxicillin + clavulanic acid, clindamycin, ibuprofen, diazepam, oxycodone, tramadol, naproxen) in both dispensing count and trend.

“Surprisingly, from 2006 to 2018, oxycodone had a steep rise even when population-adjusted with a prescribing increase of 510%.

Dr Alex Park.
Dr Alex Park.

“This may be concerning as opiates and benzodiazepines can potentially lead to dependence and even addiction.”

Dr Park also points out that while most issues pertaining to codeine were outside the study period, the medicine is still of interest in dentistry.

“From 1 February 2018, codeine-containing medications are no longer available over the counter at pharmacies,” he notes.

“Furthermore, since January 2020, codeine was no longer recommended for analgesia in dentistry. This was in accordance with the Therapeutic Guidelines set out in Australia.

“Paracetamol/codeine appears to be consistently highly used. This raises the question of whether dentists are aware of the necessary changes or whether if they are not adhering to the guidelines provided.”

He also told the AJP that in many cases, dentists do not know the cause of an infection, hence the increase in use of broad-spectrum antibiotics.

“This may be of concern for antibiotic resistance,” he said.

“What is more interesting is that no medication shows signs of slowing down.

“It is unclear whether the increase has been in prescribing is to meet the needs of patients or due to inappropriate dispensing.

“More consultation between dentists and pharmacists would be beneficial in the field to increasing understanding, and further studies to understand the use of medications in dentistry, and causes for the increase, would also be useful.

 “Our study did not compare the use of medicines by dentists compared to other prescribers, such as doctors. This could be an avenue which could be explored in the future.”

 

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