Table 1.
Descriptive characteristics of dental patient visits with concurrent opioid prescriptions by co-occurrence of potentially inappropriate medication combination (PIMC) per the Beers criteria*
| Total N= 40,800 | PIMC N= 4,239 | No-PIMC N= 36,561 | P | ||||
|---|---|---|---|---|---|---|---|
| n | (%) | n | (%) | n | (%) | ||
|
| |||||||
| Age, years | |||||||
| Mean (SD) | 71.58 | 6.64 | 72.6 | 7.13 | 71.46 | 6.57 | <.001 |
| Median (interquartile range) | 69 | 66–75 | 70 | 67–78 | 69 | 66–75 | <.001 |
| 65–74 | 29672 | 72.7 | 2796 | 66.0 | 26876 | 73.5 | <.001 |
| 75–84 | 8649 | 21.2 | 1102 | 26.0 | 7547 | 20.6 | |
| 85+ | 2479 | 6.1 | 341 | 8.0 | 2138 | 5.8 | |
| Female sex | 18350 | 45.0 | 2425 | 57.2 | 15925 | 43.6 | <.001 |
| U.S. Census Bureau Region | |||||||
| Northeast | 5606 | 13.7 | 485 | 11.4 | 5121 | 14.0 | <.001 |
| Midwest | 14381 | 35.2 | 1395 | 32.9 | 12986 | 35.5 | |
| South | 17118 | 42.0 | 2017 | 47.6 | 15101 | 41.3 | |
| West | 3683 | 9.0 | 340 | 8.0 | 3343 | 9.1 | |
| Unknown | 12 | 0.0 | 2 | 0.0 | 10 | 0.0 | |
| Dental procedure classification | |||||||
| Diagnostic | 18450 | 45.2 | 1945 | 45.9 | 16505 | 45.1 | 0.360 |
| Preventive | 1132 | 2.8 | 188 | 4.4 | 944 | 2.6 | <.001 |
| Restorative | 3293 | 8.1 | 408 | 9.6 | 2885 | 7.9 | <.001 |
| Oral and maxillofacial surgery | 24460 | 60.0 | 2477 | 58.4 | 21983 | 60.1 | 0.033 |
| Periodontics | 3395 | 8.3 | 285 | 6.7 | 3110 | 8.5 | <.001 |
| Adjunctive general services | 3314 | 8.1 | 392 | 9.2 | 2922 | 8.0 | 0.005 |
| Endodontics | 4920 | 12.1 | 471 | 11.1 | 4449 | 12.2 | 0.045 |
| Implant services | 2779 | 6.8 | 252 | 5.9 | 2527 | 6.9 | 0.018 |
| Prosthodontics | 2345 | 5.7 | 285 | 6.7 | 2060 | 5.6 | 0.004 |
| Orthodontics | 6 | 0.0 | 2 | 0.0 | 4 | 0.0 | 0.066 |
| Maxillofacial prosthetics | 27 | 0.1 | 5 | 0.1 | 22 | 0.1 | 0.166 |
| Category not available | 89 | 0.2 | 9 | 0.2 | 80 | 0.2 | 0.932 |
| Pain intensity of dental procedures** | |||||||
| Severe | 7505 | 18.4 | 880 | 20.8 | 6625 | 18.1 | <.001 |
| Moderate | 12091 | 29.6 | 1307 | 30.8 | 10784 | 29.5 | |
| Mild | 14594 | 35.8 | 1456 | 34.3 | 13138 | 35.9 | |
| Inconclusive | 6610 | 16.2 | 596 | 14.1 | 6014 | 16.4 | |
| Charlson Comorbidity Index | |||||||
| 3 | 14870 | 36.4 | 1163 | 27.4 | 13707 | 37.5 | <.001 |
| 4 | 10847 | 26.6 | 1094 | 25.8 | 9753 | 26.7 | |
| 5+ | 15083 | 37.0 | 1982 | 46.8 | 13101 | 35.8 | |
| Dental OME in mg | |||||||
| Mean (SD) | 106.03 | 6.28 | 114.77 | 85.6 | 105.01 | 5.95 | <.001 |
| Median (IQR) | 90 | 75–120 | 100 | 75–120 | 90 | 75–120 | <.001 |
| Opioid prescribed | |||||||
| Codeine | 7501 | 18.4 | 674 | 15.9 | 6827 | 18.7 | <.001 |
| Dihydrocodeine | 3 | 0.0 | 1 | 0.0 | 2 | 0.0 | 0.193 |
| Hydrocodone | 29259 | 71.7 | 3066 | 72.3 | 26193 | 71.6 | 0.348 |
| Hydromorphone | 11 | 0.0 | 2 | 0.0 | 9 | 0.0 | 0.397 |
| Meperidine | 141 | 0.3 | 18 | 0.4 | 123 | 0.3 | 0.354 |
| Morphine | 2 | 0.0 | 1 | 0.0 | 1 | 0.0 | 0.066 |
| Oxycodone | 2179 | 5.3 | 256 | 6.0 | 1923 | 5.3 | 0.033 |
| Tapentadol | 4 | 0.0 | 0 | 0.0 | 4 | 0.0 | 0.496 |
| Tramadol | 1776 | 4.4 | 234 | 5.5 | 1542 | 4.2 | <.001 |
| OME above 120 mg | |||||||
| Yes | 9192 | 22.5 | 1046 | 24.7 | 8146 | 22.3 | 0.000 |
| No | 31608 | 77.5 | 3193 | 75.3 | 28415 | 77.7 | |
| Days’ supply over 3 days | |||||||
| Yes | 19763 | 48.4 | 2121 | 50.0 | 17642 | 48.3 | 0.028 |
| No | 21037 | 51.6 | 2118 | 50.0 | 18919 | 51.7 | |
| History of mental health conditions | |||||||
| Mood disorders | 2293 | 5.6 | 752 | 17.7 | 1541 | 4.2 | <.001 |
| Psychoses | 1342 | 3.3 | 575 | 13.6 | 767 | 2.1 | <.001 |
| Behavior disorders | 1212 | 3.0 | 213 | 5.0 | 999 | 2.7 | <.001 |
| CNS-active drug exposure a day before dental visits | 8737 | 21.4 | 3944 | 93.0 | 4793 | 13.1 | <.001 |
| History of ER visits*** | 1255 | 3.1 | 181 | 4.3 | 1074 | 2.9 | <.001 |
| History of admission*** | 482 | 1.2 | 80 | 1.9 | 402 | 1.1 | <.001 |
Abbreviations: PIMC, potentially inappropriate medication combination; SD, Standard deviation; BEERS, Beers Criteria for Potentially Inappropriate Medication Use in Older Adults; OME, oral morphine equivalent; CNS, central nervous system; ER, emergency room.
Boldface indicates statistical significance accounting for up to 50 multiple comparisons and maintaining the family-wise type I error rate of 0.05.
American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674–694. doi:10.1111/jgs.15767
Pain intensity of dental procedures was defined according to Hersh, et al.1 CPT and HCPCS codes were not categorized by Hersh, et al and were categorized separately.
History of acute care utilization including hospital admission and emergency room visits were assessed in the 3 months prior to dental visit