Overdose deaths linked to opioids have reached record highs, according to a new report from the Centers for Disease Control and Prevention (CDC). While the study reveals that the sharpest increase in those deaths is due to illegal drugs such as heroin, more than one-third continue to be linked to prescription opioids such as OxyContin, Percocet, and Vicodin.

One surprising source of those drugs? The dentist.

More than half of the opioids prescribed for people who have their wisdom teeth removed have leftover pills, according to a study published in the medical journal Drug and Alcohol Dependence last September. University of Pennsylvania researchers estimate that overprescribing could add an extra 100 million opioid pills to American medicine cabinets each year.

The result? Too often those leftover narcotics wind up being misused by patients or their friends and family, says Elliot Hersh, D.M.D., Ph.D., a professor in the department of oral and maxillofacial surgery and pharmacology at Penn Dental Medicine and a co-author of the study.

“We, as dentists, have to recognize that our overprescribing contributes to the prescription opioid abuse epidemic,” Hersh says.

And evidence suggests that dentists should be recommending safer dental pain relievers. A body of research shows that over-the-counter pain relievers work just as well—or better—than opioids for most people, with far fewer side effects.

Too Many Side Effects; Too Little Relief

“It’s a myth among dentists and patients alike that opioid pain relievers are strong and OTC products are weak,” Hersh says. “Really, it’s more a matter of which medication works best against your specific type of pain.”

OTC nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, and generic) and naproxen (Aleve and generic) work particularly well against dental pain because they reduce inflammation in the traumatized areas of your mouth.

Acetaminophen (Tylenol and generic) doesn’t address inflammation, but it does an excellent job of reducing your perception of pain, Hersh says. 

The combination of a NSAID and acetaminophen works well against even moderate to severe pain in people who have had their wisdom teeth removed—better, in fact, than an opioid for most people. That's according to a comprehensive research review co-authored by Hersh that was published in the Journal of the American Dental Association in 2013.

Another advantage to OTC pain relievers is that, in general, they cause far fewer side effects than narcotic pain meds. Prescription opioids commonly cause nausea, constipation, drowsiness, and a fuzzy-headed feeling. In addition, taking the drugs longer term or in higher doses carries more serious risks, including addiction, overdose, and even death.

Making a Plan for Dental-Pain Relief

People undergoing any kind of dental surgery should “make a plan up front with their dentist or oral surgeon about how they will manage pain,” says Paul Moore, D.M.D., Ph.D., a professor in the University of Pittsburgh School of Dental Medicine and co-author of the 2013 review.

Make sure you’ve provided a thorough medical history so that your doctor can recommend pain relievers that are safest for you. Most people who take blood thinners or who have advanced kidney disease should avoid NSAIDs, for example.

It’s important to know that taking too much of any kind of pain medication—even OTC products—isn't safe. So get written instructions for how much of each type of medication to take and how often to take it.

Start with steps to reduce dental pain immediately after your procedure, when it’s likely to be most severe, Moore says.

For example, your dentist can use a long-acting anesthetic to keep you numb longer and inject your gums with a steroid to reduce swelling. You can apply cool packs when you get home and also take an NSAID before the anesthetic wears off to start controlling inflammation as soon as possible.

After that, our experts advise tailoring your treatment to your level of pain, adjusting your medications as the pain recedes. Use the table below as a guide.

A Custom Plan for Relieving Pain

Pain Level

Recommended Pain Reliever

Important Cautions

Mild

An over-the-counter NSAID such as ibuprofen (Advil, Motrin IB, and generic) or naproxen (Aleve and generic).

Mild-to-Moderate

A prescription-strength NSAID or a higher dose of an OTC product (as advised by your dentist).

Never exceed the dose of a pain reliever recommended on the product label without your provider’s OK.

Moderate-to-Severe

Both an NSAID and acetaminophen (Tylenol and generic).

Severe

An NSAID and a prescription opioid for the first 24 to 48 hours. Then stepping back to just an NSAID, or an NSAID combined with acetaminophen.

Never combine prescription opioids that contain acetaminophen, such as Percocet, Tylenol #3, and Vicodin, with an OTC product that contains acetaminophen, including pain relievers such as Tylenol as well as many cough and cold drugs. Doubling up on acetaminophen can damage the liver and can be fatal.

Moore, P. and Hersh, E., "Combining Ibuprofen and Acetaminophen for Acute Pain Management After Third Molar Extraction," Journal of the American Dental Association, Aug. 2013.

Don't Get More Opioids Than Needed

If you do wind up needing prescription opioids, your dentist should prescribe only enough to cover the first two or three days after your procedure. After that, you should be able to comfortably transition to other forms of pain relief.

Pain medications that contain codeine, such as Tylenol #3, are a good choice, Moore says, because your dentist can phone them into the pharmacy. Other types of prescription opioids are Schedule II controlled drugs, which means that your dentist will need to write a paper prescription or electronically submit it to the pharmacy through a secure system.

If You Still Wind Up With Leftovers

Don’t hang on to them. Many pharmacies, hospitals, clinics, narcotics treatment programs, and long-term-care centers will take leftover and expired medication. For example, Walgreens has installed self-service kiosks in 500 stores where you can safely dispose of medications, including opioids.

To find an authorized medication take-back program near you, go to DisposeMyMeds.org or DEAdiversion.usdoj.gov and search for "drug disposal.” Or call the DEA’s Registration Call Center at 800-882-9539.

Read more about disposing of expired or unused medication.

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).