(SLC-025) High-Risk Medications in Pediatric Dentistry: Patterns, Outcomes, and Clinical Implications

Background: High-risk medications are prescribed to children by dentists but have a narrow margin of safety. Little evidence exists on dental prescribing of high-risk medications to the pediatric population and impact on adverse outcomes.

Objectives: We aimed to determine the extent to which high-risk medications were prescribed to dental patients < 18 years and factors associated with poor outcomes.

Methods: We performed a longitudinal analysis of MarketScan Commercial and Medicaid Databases of patients < 18 years with a dental visit from 2014-2019. Among children with dental visits, we identified outpatient claims for high-risk medications, which were defined as benzodiazepines, barbiturates, and opioids. The composite all-cause outcome included hospitalization, emergency department or urgent care visit within 7 days post-visit. For opioids, attributable outcomes included opioid-related overdose within 7 days or persistent opioid use (a new opioid claim 4-365 days post-visit). Generalized estimating equations (GEEs) with a first-order autoregressive correlation matrix were used to model the association between outcomes and characteristics.

Results: Among pediatric dental visits from 2014-2019, 0.7% (n=269,992) involved high-risk medications (91.2% opioids, 5.7% benzodiazepines/barbiturates, and 3.1% opioids + benzodiazepines/barbiturates). Among dental visits with high-risk medications, 4.3% had an all-cause outcome. Patients 9-11 years (OR 1.58 [95% CI 1.48-1.68]), males (OR 1.05 [95% CI 1.01-1.09]), with complex chronic conditions (OR 2.20 [95% CI 2.04-2.37]), and dental care delivered in hospitals or ambulatory surgery (OR 2.18 [95% CI 1.95-2.40]) were associated with the all-cause outcome. Of dental visits with opioids, 10.1% had an attributable outcome (71.3% persistent use 4-90 days post-visit, 28.7% persistent use 91-365 days, 0.3% opioid overdose) with the highest risk observed in patients 4-5 years (OR 1.48 [95% CI 1.39-1.58]), females (OR 1.08 [95% CI 1.05-1.11]), with complex chronic conditions (OR 1.22 [95% CI 1.14-1.30]), congenital malformations (OR 1.32 [95% CI 1.15-1.48]), and care delivered in dental clinics (OR 1.43 [95% CI 1.30-1.61]).

Conclusions: Adverse outcomes were associated with dental prescribing of high-risk medications to children. Our findings highlight the widespread use of opioids in pediatric dentistry and their association with poor outcomes, particularly in younger children. The highest risk of opioid-attributable outcomes in children 4-5 years emphasizes the need for caution in opioid prescribing and support guidelines which exclusively recommend non-opioid analgesics. However, additional interventions are necessary to minimize the risk associated with dental prescribing to children.