Narcotic prescribing habits and other methods of pain control by oral and maxillofacial surgeons after impacted third molar removal

J Oral Maxillofac Surg. 2013 Sep;71(9):1500-3. doi: 10.1016/j.joms.2013.04.031.


Purpose: It has been suggested that a source of narcotics used for nonmedical purposes by young adults is the unused opioids prescribed for the management of pain after the removal of impacted third molars. The purpose of the present study was to determine whether oral and maxillofacial surgeons routinely prescribe larger amounts of a narcotic than would generally be needed for adequate postoperative pain control. A secondary goal was to determine whether they use methods other than analgesic drugs to minimize postoperative pain and thereby reduce the amount of narcotic that might be needed.

Patients and methods: An 8-question survey was sent to 100 randomly selected oral and maxillofacial surgeon members of the American Association of Oral and Maxillofacial Surgeons in each of the 6 association districts. The questions asked were related to whether a narcotic was routinely prescribed for patients who have had impacted teeth removed, the most common drug used, and the dosage and number of tablets prescribed. The participants were also asked whether they had pretreated patients with a nonsteroidal anti-inflammatory drug or had prescribed one along with the narcotic, had injected a steroid, or had used a long-lasting local anesthetic postoperatively.

Results: Only 2 of the 384 respondents stated that they did not prescribe a narcotic for patients who had had impacted teeth removed. Hydrocodone (5 mg) was the most frequently prescribed narcotic. The number of tablets varied from 10 to 40, but the most common number was 20 tablets. However, 80 respondents (22%) prescribed more, with 40 prescribing 30 tablets. Also, 80% of the respondents injected their patients with a steroid, and 62% injected a long-lasting local anesthetic postoperatively. Only 34% pretreated their patients with a nonsteroidal anti-inflammatory drug, but 66% recommended such use postoperatively.

Conclusions: Most oral and maxillofacial surgeons prescribe analgesic drugs of an appropriate type and dosage and use proper adjunctive pain control measures to supplement these drugs. However, our findings also indicated that more than 20% prescribe more tablets than would generally be necessary to control the postoperative pain after the removal of impacted third molars. This could be a source of drug diversion and nonmedical use by young adults and should be avoided.

MeSH terms

  • Anesthetics, Local / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Attitude of Health Personnel
  • Humans
  • Hydrocodone / administration & dosage
  • Hydrocodone / therapeutic use
  • Injections
  • Molar, Third / surgery*
  • Narcotics / administration & dosage
  • Narcotics / therapeutic use*
  • Oxycodone / administration & dosage
  • Oxycodone / therapeutic use
  • Pain, Postoperative / prevention & control*
  • Practice Patterns, Dentists'*
  • Premedication
  • Prescription Drugs*
  • Steroids / administration & dosage
  • Steroids / therapeutic use
  • Surgery, Oral*
  • Tooth Extraction
  • Tooth, Impacted / surgery*


  • Anesthetics, Local
  • Anti-Inflammatory Agents, Non-Steroidal
  • Narcotics
  • Prescription Drugs
  • Steroids
  • Hydrocodone
  • Oxycodone