Opioid-Tolerant Patients Far More Likely to Return With Pain After Minor Oral Surgery

Edited by Dentaltown staff

Opioid-tolerant patients were far more likely than opioid-naive patients to return after minor oral surgery with pain requiring additional opioid analgesia, according to a retrospective cohort study published Oct. 21 in Clinical Oral Investigations.

Researchers reviewed 1,263 records of patients who had simple or surgical extractions under local anesthesia at a single public oral surgery service in New South Wales, Australia, between May 2020 and May 2024. Of those, 184 patients were opioid tolerant and 1,079 were opioid naive.

Patients were classified as opioid tolerant if they met any of these criteria:

• prescribed opioids for longer than one month

• receiving methadone therapy

• reporting current illicit opioid use

• having a documented history of opioid use disorder

All patients received standard postoperative analgesia of acetaminophen and NSAIDs unless contraindicated, with opioids reserved for those who returned with uncontrolled pain.

Overall, 28.8% of opioid-tolerant patients returned with pain requiring additional opioid analgesia, compared with 2.2% of opioid-naive patients, for an adjusted odds ratio of 24.59 (95% CI, 13.26–45.62). The association held across demographic subgroups and extraction types.

No opioid-naive patient returned after a simple extraction. Among opioid-tolerant patients, 23.8% returned after simple extractions and about 30% after surgical extractions. Thirty of the 53 opioid-tolerant patients who returned had been taking daily doses at or below 12 mg oral morphine equivalent, corresponding to weak regimens such as acetaminophen with codeine, a finding the authors said should be interpreted cautiously.

The authors concluded that current postoperative analgesic pathways may not fully meet the needs of some opioid-exposed patients. They noted that current dental guidelines do not specifically address postoperative pain in this group and called for randomized trials to guide care.

Adarsh Gopinath, Femi E. Ayeni, and Stephen Cox of Nepean Hospital, the Western NSW Oral Health Service, and the University of Sydney conducted the study. They reported no funding and no competing interests.

The design was retrospective and drew on a single center. The outcome was a return visit requiring additional opioids rather than pain measured on a validated scale.

Sources:
Clinical Oral Investigations, “Postoperative pain outcomes following minor oral surgery in opioid tolerant patients: a retrospective cohort study,” published Oct. 21, 2026: link.springer.com/10.1007/s00784-026-07229-4