Trends in High-risk Prescribing to U.S. Pediatric Dental Patients, 2012-2019

Background: U.S. dentists frequently prescribe high-risk medications, including to children < 18 years. Opioids, sedatives, and anxiolytics can manage pediatric dental fear and pain. However, child death has occurred after administration in dental settings. Few studies have assessed recent prescribing trends, especially for non-opioids.

Objectives: To characterize rates of high-risk prescribing to US pediatric dental patients from 2012 to 2019.

Methods: The current study utilized the IQVIA LRx dataset, which captures 92% of all filled outpatient prescriptions by dentists from 2012 to 2019. High risk prescriptions to children included: opioids, sedatives, benzodiazepines, stimulants, and gabapentin. National trends were calculated using join-point models.

Results: From 2012 to 2019, 3.8 million children were exposed to high-risk dental prescriptions (17% of all prescriptions). Among high-risk drugs, opioids were the most common (74.9%), followed by sedatives (12.5%), benzodiazepines (11.7%), stimulants (0.6%) and gabapentin (0.2%). National prescribing rates decreased 63.1% from 10456 to 3859 days per million children between 2012 and 2019. The decrease was most prominent after 2016 (-6.0% per quarter, vs. -1.6% pre-2016, P-value < 0.001), especially for opioids (-7.0% vs. -1.2%, P-value < 0.001). Adolescents (15-17 years) had high exposure to hydrocodone, which decreased from 12560 to 6572 days per million (-2.0% per quarter) but, unlike other opioids, did not decrease in 2016. Prescribing of tramadol in children < 5 & 5-9 years was 14.3 & 59.8 per million in 2019, despite FDA contraindications in 2017. Gabapentin rates increased by 8.1%, from 122 to 132 per million. Stimulants had the largest decrease of -89.3%, from 826 to 89 per million.

Conclusions: We observed promising decreases in pediatric dental prescribing of high-risk medications from 2012-2019. Decreases in opioid prescribing in 2016 suggest spillover effects of CDC guidelines for adults with chronic pain. Although rare, gabapentin prescribing increased, suggesting possible substitution effects in response to opioid restrictions. High opioid prescribing among adolescents suggests a need for more tailored policies in this age group. Additionally, dentists continue to prescribe stimulants at low rates, despite no dental indication.