Opioids for dental pain still more common in US

 

Despite recent 27% drop in patients filling dental opioid prescriptions, rate is still higher in U.S. states than in Puerto Rico and six other developed countries

Peer-Reviewed Publication

Michigan Medicine - University of Michigan

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People getting their teeth pulled or drilled by dentists in the United States are still much more likely to get powerful opioid medications than dental patients in other developed countries or even the U.S. territory of Puerto Rico, a new study finds.

That’s despite steep drops in dental opioid prescription fills in recent years in the U.S., according to the new findings from a team from the University of Michigan Medical School and University of New South Wales published in the journal JAMA Network Open.

Dentists worldwide have worked in recent years to move away from prescribing opioids for routine dental procedure pain.

Newer dental care guidelines encourage them to advise patients to use other types of pain medication because of the risk that prescription opioids can lead to long-term use, the form of addiction called opioid use disorder, accidental poisoning or overdose.

From 2021 to 2024, the new study shows, there was a 27% drop in the rate of patients in U.S. states filling prescriptions from dentists for opioids, and a 10% drop in Puerto Rico. There were also double-digit decreases in four developed countries the researchers analyzed: Canada, France, Australia and Germany.

But by the end of 2024, the U.S. still had the highest rate of such prescription fills, though it had closed the gap with Canada, the country with the next-highest rate.

By contrast, the Netherlands had a dental opioids prescription fill rate that was 24 times lower than the U.S. rate. In the Netherlands in 2024, just 83 prescriptions for dental opioids were filled for every 100,000 inhabitants. In the U.S., 2,022 such prescriptions were filled for every 100,000 people.

Kao-Ping Chua, M.D., Ph.D., the lead author of the new study, has tracked dental opioid prescribing patters in the U.S. and other countries for years.

“Our study shows that the US dental opioid dispensing rate is decreasing but remains high by international standards", said Chua, who is an Associate Professor of Pediatrics at the U-M Medical School and of Health Management and Policy at the U-M School of Public Health. "This finding suggests that some U.S. dentists are still overprescribing opioids."

Chua is also director of the Susan B. Meister Child Health Evaluation and Research Center or CHEAR.

In 2023, Chua and colleagues showed that the rate of prescribing in the U.S. had dropped 45% between 2016 and 2022., though the progress slowed after the start of the COVID-19 pandemic. Even so, the 2022 rate in the U.S. was four times the 2016 rate in the United Kingdom. The new study does not include UK data.

The senior author of the new paper, Chad Brummett, M.D., is a Professor of Anesthesiology at U-M and co-director of the U-M Opioid Research Institute and the U-M-based opioid guideline and education effort called OPEN.

OPEN offers guides and educational materials for opioid-sparing pain care for dental and oral surgery patients. They’re available for free and have been updated several times.

Chua and Brummett are members of the U-M Institute for Healthcare Policy and Innovation; Romesh Nalliah, DDS, a co-author, was also a member during his time on the U-M faculty. Other authors are three members of the University of New South Wales in Sydney, Australia: Claudia Bruno, Ph.D.; Sallie-Anne Pearson, Ph.D., and Jonathan Brett, MBBS, Ph.D., and Siljia He, M.S., a CHEAR statistician.

The study was funded by the Benter Foundation, with additional funding by the National Institute on Drug Abuse of the National Institutes of Health (R01DA056438, R01DA057284, and R01DA057943), and the Australian National Health and Medical Research Council (1196900, 1196560).

Reference: International Trends in Dental Opioid Prescriptions, JAMA Network Open, doi:10.1001/jamanetworkopen.2026.7824

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2026.7824 

Fighting oral cancer with bioengineered chewing gum

 

Researchers led by Henry Daniell of the School of Dental Medicine have shown that extracts from bioengineered chewing gum reduce the levels of three microbes known to be associated with head and neck squamous cell cancer (HNSCC), paving the way for more effective and affordable therapies. Their findings are published in Scientific Reports.

Head and neck squamous cell carcinoma (HNSCC) is a common cancer that develops in the lining of the mouth and throat. It can be aggressive and often has poor outcomes, especially when diagnosed at advanced stages, says Daniell. He notes that most recently approved cancer drugs have not significantly improved quality-of-life or five-year survival rates, underscoring the need for better therapies.

Building from their previous work using a chewing gum made from lablab beans (bean gum) containing the naturally antiviral protein FRIL, Daniell and colleagues examined the levels of three microbes linked to cancer—human papilloma virus, or HPV, and two species of bacteria, Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn)—in oral samples from patients with HNSCC.

“The global increase in oropharyngeal cancer is linked to HPV infection,” says Daniell. “And Pg and Fn infections worsen survival rates of untreated recurrent or metastatic oral cancer, even after surgery and risk-adjusted adjuvant, or supplemental, therapies.”

They found that bean gum extracts reduced HPV levels by 93% in saliva samples and by 80% in oral rinse samples. When they bioengineered the bean gum to also contain protegrin, an antimicrobial peptide that can kill harmful bacteria, they found that a single dose reduced the levels of Pg and Fn to almost zero without affecting the beneficial bacteria normally found in the mouth. This contrasts with radiation therapy, which both reduces beneficial bacteria and increases disease-causing yeast (Candida albicans).

“Lip and oral cavity cancer was the seventh leading cancer type in cancer incidence and mortality rate worldwide in adolescents, young adults, and middle-aged adults in 2022,” says Daniell. “Our findings support the value of advancing these therapies to clinical trials as adjuvants with current treatments or as prophylaxis to prevent infection and transmission.”

Henry Daniell is the W.D. Miller Professor in the Department of Basic & Translational Sciences at the School of Dental Medicine at the University of Pennsylvania.

Other authors are Geetanjali Wakade,& Rahul Singh, and Smruti Nair of Penn Dental Medicine; Andrés M. Bur and Sufi M. Thomas of the University of Kansas Medical Center; Eri S. Srivatsan and Marilene B. Wang of the University of California at Los Angeles; and Saroj K. Basak of the Veterans Administration Greater Los Angeles Healthcare System.

This work was supported NIH (grant 5-R01-HL 107904-13 awarded to Henry Daniell), the Academic Senate Grant of David Geffen School of Medicine at UCLA (the Surgical Education Research program), and National Cancer Institute Cancer Center (Support Grant P30 CA168524).

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Journal

Scientific Reports

DOI

10.1038/s41598-026-39062-w 

Silicone toothbrushes: An underutilized tool in global oral health

 COMPLETE REPORT

Oral diseases are the most prevalent non-communicable diseases worldwide, affecting 3.5 billion people, with a disproportionate impact on those living in low- and middle-income countries. Current oral health promotion strategies rely heavily on plastic and nylon toothbrushes, which present both environmental and accessibility challenges. In response to the growing need for sustainable and affordable preventive oral health solutions, there has been increasing interest in alternatives to conventional toothbrushes. This scoping review aimed to summarize the global literature on silicone toothbrushes, an underutilized tool in preventive oral care. A systematic search of five databases, supplemented by reference screening, identified ten English-language studies investigating silicone toothbrushes. Findings suggest that silicone toothbrushes are effective in plaque removal, have a lower risk of gingival trauma, are well-suited for specific populations, and perform better in environmental impact assessments.

Plaque removal effectiveness

Dental plaque removal effectiveness was a central focus across most included studies. For example, two studies found that silicone toothbrushes demonstrated comparable plaque removal to plastic and nylon toothbrushes among post-secondary students [and children who brushed their teeth or who had support from parents. U-shaped automatic electric toothbrushes with silicone bristles were not effective at removing plaque compared to conventional and habitual toothbrushing practices. The authors suggest that the optimal hardness of the silicone toothbrushes was 60 Shore A, however, there was no soft tissue damage among all hardness levels. Threaded bristles significantly improved the dental plaque removal of silicone toothbrushes. Moreover, their findings indicate that silicone toothbrushes are equally as effective at removing plaque under both wet and dry brushing conditions.

Kids most in need of dental care least likely to benefit from school programs

 

Children who don’t go to the dentist are less likely to participate in school-based cavity prevention programs, according to research published in JAMA Network Open.

“Our study suggests that children who may need these services the most are the ones least likely to receive them,” said health economist and study author Shulamite Huang, an assistant professor of epidemiology and health promotion at NYU College of Dentistry.

In addition, the study found that improving participation in state-wide school dental programs to reach those at high risk for tooth decay could yield significant savings for state Medicaid programs and health care systems, averting up to $2.4 million in emergency department charges annually in New York. 

Children miss more than 34 million hours of school each year to receive emergency dental care. In recent years, hospitals have seen a sharp increase in emergency room visits for pediatric dental issues. 

To prevent tooth decay and the related pain and infections that land kids in the ER, some schools offer cavity prevention programs. New York State recently announced a $10 million initiative to expand access to school-based dental programs and improve children’s oral health.

Research shows that school dental programs, which use non-invasive treatments like sealants, are effective at preventing cavities. But parents must opt in for their kids to receive care in school, and it’s unclear if these programs reach those who are most in need. 

Huang and her colleagues evaluated data from more than 63,000 children living in the Bronx and covered by Medicaid, including more than 1,000 children who participated in school-based cavity prevention programs in local elementary schools. They looked at Medicaid claims data to see whether children had visited a dentist outside of school or received emergency dental care.

 The researchers found that kids who already had a history of dental care were more likely to participate in school-based cavity prevention programs. In contrast, children with no prior dental visits were 18 percent less likely to participate in these programs. Children with a history of dental emergencies (and probably at high risk for tooth decay) were also less likely to participate in school-based programs. 

The researchers then calculated the potential cost savings of expanding school-based dental care across New York State and improving participation among the children most at risk for tooth decay. They estimate that optimizing recruitment to enroll high-need children in school programs could save the state up to $2.4 million annually in dental-related emergency department costs (not including dental care related to accidents or injuries).

“This has staggering implications for Medicaid costs,” said Huang. “As New York expands access to school-based dental care, improving recruitment strategies and reorienting outreach to high risk-children could save the state millions and offset some of the costs of expanding care.”

Can’t afford dental care = higher risk of developing cardiovascular disease, dementia

 Being unable to afford dental care may increase a person’s risk of developing cardiovascular disease or dementia, according to a new study led by researchers at Boston University School of Public Health (BUSPH).

Published in The Journals of Gerontology, Series A, the study found that older people who forego necessary dental procedures because of financial barriers may be more likely to experience heart failure, a heart attack, a stroke, or dementia.

Poor oral health has been previously linked to cardiovascular and neurological conditions, but the prior research was mostly limited to specific oral health issues, such as periodontitis or tooth loss. Being unable to pay for dental care is a modifiable problem that, if addressed, could potentially lower people’s chances of developing more serious or fatal health conditions.

“Cost is one of the main barriers to dental care,” says study lead author Ms. Mabeline Velez, an instructor of health policy and health services research at BUSPH and a PhD candidate at Boston University’s Henry M. Goldman School of Dental Medicine. “As a result, people often delay critical care or they accept the coverage available, which may be more drastic measures—such as getting a tooth pulled than is clinically indicated. Tooth loss, especially early in life, can cause a whole set of health problems later in life including increased mortality. Finding ways to make dental care more accessible and affordable for everyone is a preventative measure that we can take to improve health outcomes down the line.”

For the study, Velez and colleagues from BUSPH and the University of California, San Francisco utilized survey data among participants ages 55 and older in the All of Us study, an initiative that the National Institutes of Health launched in 2017 to develop a diverse database on a variety of health conditions. Analyzing electronic health records and survey responses, the team examined the associations of unmet dental care needs due to cost with new diagnoses of heart failure, heart attacks, strokes, and all-cause dementia. A total of 88,496 people were analyzed for incident heart attacks, 86,593 people for heart failure, 88,410 people for strokes, and 92,272 people for dementia.

They found that people who skipped dental checkups and procedures because they could not afford them had higher incidence of all of the above conditions. On a population level, eliminating the financial barriers that prevented people from receiving dental care could prevent 2-4 percent of each outcome among older adults. With the exception of strokes, the associations were reduced after the researchers accounted for socioeconomic, behavioral, and clinical factors. 

The researchers note that this weakened relationship signals that further data is needed to understand and address the underlying or systemic drivers of chronic diseases.

“Multiple studies have evaluated pieces of this puzzle, but this is the first time we can point to  financial barriers to care as being linked with the incidence of cardiovascular disease and dementia: two leading causes of disability and death among older adults,” says study senior author Dr. Kendra Sims, assistant professor of epidemiology at BUSPH. “This study serves as an indicator that if we alleviate upstream factors such as financial constraints, we can prevent chronic disease.”

Fewer than 30 percent of US adults 65 and older have dental insurance and nearly 8 percent say they are unable to afford necessary dental care. Medicare and Medicaid do provide dental coverage, but that coverage is limited and often excludes preventive services. Medicaid dental coverage also varies widely by state, and in some instances, only covers emergency care. 

Policies that facilitate access to preventive dental care could widely reduce poor oral health outcomes, with benefits that extend to cardiovascular and cognitive outcomes, the researchers say. For example, states that extended dental care under the Affordable Care Act reported an increase in dental visits, fewer missing teeth, and better overall oral functioning. 

These dental visits also present an opportunity to conduct other health screenings.

“People who can access and afford routine dental care typically visit the dentist twice a year,” Dr. Sims says. “What if insurance could cover screening for cardiovascular risk factors like diabetes or hypertension when a patient is in the chair?” 

For her dissertation, Ms. Velez is exploring how periodontitis, a condition where plaque built up on the gums causes inflammation and infection, can eventually lead to cardiovascular issues. 

“Periodontitis is very common, but it is a treatable disease,” she says. “I hope this new insight will encourage doctors to integrate dental care into general practice.”

A stiff defense: Rethinking gum disease

Penn Dental Medicine’s Kyle H. Vining and Hardik Makkar take a biomaterials approach to understanding periodontal disease, using a hydrogel system to investigate how the physical properties of the gum tissue impact inflammation.

Peer-Reviewed Publication

University of Pennsylvania

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Periodontitis is a serious chronic inflammatory form of gum disease that affects millions worldwide. It can lead to tooth loss and the destruction of supporting bone. This disease has also been linked to other health problems, including diabetes, respiratory infections, and heart disease—impacting quality of life and increasing health care costs.

Current treatments target bacterial infection and inflammation through nonsurgical therapies, such as scaling and root planing, commonly known as “deep cleaning.” However, they do not repair the gum’s extracellular matrix (ECM), the gingival tissue’s structural support that is damaged by chronic inflammation. Without this foundation, gingival tissue cannot function properly, allowing inflammation to persist and slowing healing.

Now, new research led by Kyle H. Vining and Hardik Makkar of the School of Dental Medicine demonstrates how the physical properties of the gingival tissue impact periodontal health and disease. Their findings are published in Advanced Materials.

Other studies have shown that physical properties such as structure and stiffness influence inflammation in chronic conditions such as rheumatoid arthritis and fibrosis, explains Vining, an assistant professor in Penn Dental Medicine’s Department of Preventive and Restorative Sciences. But the role of these properties in periodontal disease, which shares characteristics with other chronic inflammatory diseases, is not well understood.

“So, in this study, we took a biomaterials approach to prove that rigidity—the stiffness—of the healthy gingiva is important for maintaining gingival health,” says Vining, who is also an assistant professor in the School of Engineering and Applied Science.

The team used a “tunable” hydrogel composed of natural biopolymers, resembling a form of Jell-O, to isolate how the mechanical environment influences cellular behavior. “Hydrogel stiffness can be tuned to model the properties of human gingiva, from the firmness of healthy tissue to the softened features of diseased tissue,” he says.

They first encapsulated gingival fibroblasts—the predominant cell type in the connective tissue of the gums that is responsible for secreting and maintaining the ECM—in this hydrogel system to test whether changes in tissue stiffness drive these cells to exacerbate the inflammatory response that characterizes periodontal disease.

“In periodontal disease, bacteria secrete enzymes that break down the ECM, causing the tissue to soften,” says Makkar, a postdoctoral fellow in Vining's lab. And as the tissue softens, he adds, cells shift into a higher inflammatory state that triggers even more tissue degradation, creating a destructive feedback loop in which tissue damage and inflammation feed each other.

“When we stiffen these tissues experimentally, the inflammatory response goes down,” says Makkar.

To validate these results, the team used enzymes—instead of the hydrogel—to restore stiffness in human gingival tissue samples obtained from Penn Dental’s dental clinic and found that when they exposed them to microbial triggers, the stiffened tissues showed a significantly lower inflammatory response.

“By using a more human-centric research model, we’ve demonstrated that simply restoring the physical stiffness of the tissue can fundamentally change how cells respond to infection,” says Makkar.

This work contributes to a better understanding of the mechanisms underlying the inflammatory response in periodontal disease, says Vining. But these findings could also pave the way for new biomaterial-based therapies to complement current treatments that target only microbes.

“We envision developing an injectable filler,” he says. “So, if you have uncontrolled periodontal disease, and even after deep cleaning, the tissue is frail, we could inject the filler to help the tissue heal.” Vining notes that these fillers could ultimately make grafts more successful or perhaps even unnecessary.

“There is a lot we can do with the tissue itself,” adds Makkar, including “strengthening it so that it becomes much more resistant to potential future infections.”

Next steps for the team are twofold. One, says Makkar, is to use small molecules to inhibit the inflammatory pathways to better understand the mechanisms underlying these findings. And the second is to do proof-of-concept studies of injectable biomaterials to help treat periodontitis.

“Dental research is moving far beyond traditional treatments,” says Vining. “Our work exists at the interface of materials science and bioengineering. Penn is one of the few places in the world with the collaboration and infrastructure required to bridge these fields, allowing us to develop next-generation therapies to treat dental, oral, and craniofacial diseases."

Kyle H. Vining is an assistant professor in Penn Dental Medicine’s Department of Preventive and Restorative Sciences and in Penn Engineering’s Department of Materials Science and Engineering.

Hardik Makkar is a postdoctoral fellow in the Vining Lab.

Other authors are Kang I. Ko of Penn Dental, Yu-Chang Chen and Nghi Tran of Penn Engineering, and Rebecca G. Wells of the Perelman School of Medicine.

This work was supported by the National Institute of Dental and Craniofacial Research (NIDCR) through a training grant to the Center for Innovation & Precision Dentistry (CiPD) (R90DE031532 to Hardik Makkar). Additional support was provided in part by the Collaborative Research Grant from the Institute for Regenerative Medicine in the Perelman School of Medicine and the School of Dental Medicine at the University of Pennsylvania (Vining). This study was also partially supported by the National Institute of General Medical Sciences (NIGMS) (R35GM157079, Vining and Chen) and by a Graduate Research Fellowship from the National Science Foundation (No. DGE-2236662, Nghi Tran). Confocal microscopy was performed on an instrument purchased with support from an NIH Shared Instrumentation Grant (S10 OD032305-01A1).

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Journal

Advanced Materials

DOI

10.1002/adma.202520717 

Clear link between chronic kidney disease and periodontal disease

 

Recently analyzed evidence points to a connection between oral health and kidney health, according to work led by University of Cincinnati College of Medicine researchers.
Their article in BMC Nephrology combined evidence from more than 150 previously published papers, including observational studies, meta-analyses and interventional trials, and identified growing evidence of oral-renal interactions.

“We know there is an association between chronic kidney disease (CKD) and oral diseases,” said Priyanka Gudsoorkar, the study’s first author and an assistant professor-educator in the Department of Environmental and Public Health Sciences. “The emerging evidence supports a bidirectional relationship.”
Researchers said the relationship appears to be driven by immune dysregulation, endothelial dysfunction (narrowing of the blood vessels), microbial dysbiosis (oral microbial imbalance) and systemic inflammation. Periodontal disease and CKD have interlinked inflammatory pathways that may contribute to disease progression.

“Systemic inflammation is linked to a triad of other conditions: diabetes mellitus, cardiovascular disease and hypertension encompassing metabolic syndrome,” said Prakash Gudsoorkar, MD, the study’s corresponding author and an associate professor in the Division of Nephrology in the Department of Internal Medicine. He added that patients with kidney disease at all stages face increased risk for these conditions.

“This triad operates as a clinical cascade,” said Prakash Gudsoorkar, who is also a UC Health nephrologist. Diabetes and hypertension accelerate the decline of kidney function, while cardiovascular disease becomes a dominant risk factor. CKD also multiplies the risk of complications involving glycemic control, medication management and complex care needs. 

“We see oral disease severity increase as CKD progresses, and the literature supports a biologically plausible relationship,” said Priyanka Gudsoorkar. “What we still need are well-designed prospective studies and clinical trials to clarify the direction and magnitude of causality.”
However, the study found many physicians still treat oral health separately from chronic disease, rather than integrating it into a broader treatment strategy that could allow for earlier identification and better risk assessment.
This disconnect can be especially significant for patients undergoing dialysis and awaiting kidney transplants. Pretransplant dental clearance is typically required before surgery. For some patients, kidney transplant waits can stretch for years, and untreated oral infections can delay the procedure and become a preventable barrier to transplant readiness.

“Oral infection and untreated periodontal disease can complicate continuity of care,” said Priyanka Gudsoorkar, who is also director of the global health concentration within UC’s Bachelor of Science in Public Health program. 

“For many patients, transplant evaluation is the first point in their kidney care journey when a dental referral becomes a standard requirement,” she said. “So closer monitoring of oral health in patients on dialysis is needed, along with better management of periodontal inflammation.”

CALL FOR CARE INTEGRATION

Researchers are now calling on physicians to begin integrating oral and renal health more directly within clinical care systems. “We need to build a framework that supports oral and renal care integration across the CKD continuum,” said Prakash Gudsoorkar.

An improved framework, which could include implementing standardized care protocols and improved sharing of patient health records across specialties, could also enable earlier intervention and ease economic burden for patients, he explained.

TOPIC GAINS ATTENTION

As evidence of a link between CKD and oral diseases grows, the topic has gained attention among leading clinicians and researchers. 

“Mouth and Kidneys: Unveiling the Crosstalk Between Oral and Kidney Health,” written by Priyanka Gudsoorkar, Prakash Gudsoorkar and Sujay Mehta and published in the American Society of Nephrology’s Kidney News, was selected by the publication’s editor-in-chief as one of its top five articles of 2025. 

Highlighting the need for policy reform, Priyanka Gudsoorkar and Prakash Gudsoorkar also published a perspective in late 2025 in the International Dental Journal: “Integrating Oral Health Into Kidney Care: A Policy Imperative for Chronic Kidney Disease, the U.S. Experience.” 

The authors and other experts in clinical dentistry and nephrology have formed the Oral-Kidney Collaborative for Advancing Research and Evidence (OK-CARE), a multidisciplinary initiative to advance research, clinical collaboration and policy development at the intersection of oral health and kidney disease. 

Collaborators outside UC include: C. Elena Cervantes of Johns Hopkins School of Medicine; Isabella Lerma of Marquette University; Anay Dudhbhate of George Brown Polytechnic in Toronto, Canada; Sujay Mehta and Ramprasad Vasthare of Manipal College of Dental Sciences in Udupi, India; Edgar Lerma of the University of Illinois at Chicago; Lakshman Samaranayake and Chun Wang Chau of the University of Hong Kong; Sabine Karam of the University of Minnesota; Sompop Bencharit and Abhjit Kshirsagar of the University of North Carolina at Chapel Hill; and Ryan S. Lee, a dental subject matter expert.

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Journal

BMC Nephrology

Method of Research

Literature review

Subject of Research

People

Article Title

Bridging systems: oral-kidney connections - pathophysiological links, clinical implications, and health system integration – a narrative review