While the conversation surrounding teen opioid addiction is primarily focused on post-athletic injury prescriptions, there’s another key scenario that’s often overlooked: wisdom teeth removal. Wisdom teeth surgery typically occurs during the teenage years and is frequently coupled with a prescription for pain medication. In fact, 80 percent of young adults take an opioid for the first time when they get their wisdom teeth out. Unfortunately, in some cases, this is also the catalyst to an addiction.
In an exclusive interview, Dr. B.D. Tiner, a board-certified oral and maxillofacial surgeon who uses non-opioid medications for patients, explained how dangerous of a slippery a slope the wisdom teeth extraction procedure can be — and how teens could end up with an addiction in the process. New research shows that even those prescribed short-term opioids can become addicted to them.
According to Dr. Tiner, who practices in New York City, 80 percent of high school and college students are first introduced to opioids when they have their wisdom teeth removed.1
He also said that 70 percent of them would have chosen a non-opioid medication if given the opportunity.
As a result of this research, Dr. Tiner works to give patients this choice, offering Exparel, a drug that works like Novocain and is injected around the surgery site, as an alternative. With Exparel, the pain relief is long-lasting and continues working well after the surgery is completed. However, Exparel is not recommended for use in children younger than age 18, so some patients choose to put off the surgery and, many times, needed orthodontia treatment.
Exparel is not a narcotic. According to OralSurgeryPrep.com, a website run by Pacira Pharmaceuticals, maker of Exparel, patients must have honest discussions with their doctors before surgery. Discuss your complete medical history including medications you’re taking, allergies, breathing/respiratory issues, stomach problems and especially any history of substance use disorder.2
“Exparel starts controlling postsurgical pain before you wake up from surgery – your doctor injects it directly into the site of your surgery during the procedure,” the pharmaceutical company explains on the Exparel website.3
There is one unfortunate reality when it comes to Exparel, though: paying for it. When asked whether most insurance plans will cover the cost of Exparel, Tiner admits, “It varies significantly,” adding, “It is a new drug, and as with any new drug, there are costs involved. In most cases, insurance does not reimburse.”
“During a surgical pre-consultation appointment, we have a frank discussion about what to expect from pain, when to return to normal activities, and we give the patient or caregiver options on how to manage post-operative pain, either with opioids or Exparel,” Tiner said.
He said patients are well aware of the dangers of opioid addiction. “You just can’t pick up a newspaper, turn on the TV or even look at your email without another article about the opioid crisis. We are getting lots of questions along the lines of, ‘Is there another way other than opioids to manage the pain?'”
The American Dental Association has issued a statement on the use of opioids. It includes, first and foremost:
“When considering prescribing opioids, dentists should conduct a medical and dental history to determine current medications, potential drug interactions and a history of substance abuse.”
It adds, “Dentists who are practicing in good faith and who use professional judgement regarding the prescription of opioids for the treatment of pain should not be held responsible for the willful and deceptive behavior of patients who successfully obtain opioids for non-dental purposes.”
The recommendations also urge dentists to register with and use prescription drug monitoring programs in their states “to promote the appropriate use of controlled substances for legitimate medicinal purposes while deterring the misuse, abuse and diversion of these substances.”
The American Dental Association “should consider non-steroidal anti-inflammatory analgesics as the first-line therapy for acute pain management,” the guidelines state.4
For the most part, Tiner said, patients asking for opioids, or more than they should be prescribed, isn’t a problem. Most people come in for a one-time dental procedure and would have a difficult time explaining why they would need more opioids. “This isn’t like chronic back pain,” he said.
But a recent NPR report showed just how serious the problem of teens becoming opioid addicts after getting their wisdom teeth out really is. Using personal stories of the addicted, the reporter showed how wisdom teeth extractions have become the talk of high schools across the country.
“We’re in our 2001 Honda Odyssey minivan, driving to the dentist, “James Hatzell of Collingswood, New Jersey, recalls in his interview with NPR. “And we get there, and I’m just pumped. I was very excited to get my wisdom teeth out.”
He already had heard from his friends that you get some great drugs when you leave. And those drugs eventually derailed his life. By college, he was dealing them.
Dr. Eilliot Hersh, Professor of Pharmacology and Oral Surgery at University of Pennsylvania School of Dental Medicine, told NPR he brings in retired narcotics officers to speak to his students.
“I’ve been teaching my students that you have to be really, really careful with these drugs,” he said. “That if you write too many of these prescriptions, for either good or bad intentions, either the state dental board and/or the DEA (Drug Enforcement Agency) is going to come down on you.”5
1. Personal telephone interview. (May 2017). Dr. B.D. Tiner.
2. Pacira Pharmaceuticals. “Start the Conversation: Questions to Ask Before Your Oral Surgery.” (2017). OralSurgeryPrep.com. Retrieved May 29, 2017.
3. Pacira Pharmaceuticals. “What is Exparel?” Retrieved May 29, 2017,.
4. American Dental Association. “Statement on the Use of Opioids in the Treatment of Dental Pain.” Retrieved May 29, 2017.
5. Gordon, E. (2017, Feb. 26). “Dentists Work to Ease Patients’ Pain With Fewer Opioids.” National Public Radio. Retrieved May 29, 2017.
Written by David Heitz