High-risk medicines in children’s dentistry

Dental Tribune International

Fri. 2 January 2026

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PITTSBURGH, US: Prescribing high-risk medicines in children’s dentistry remains uncommon but, carries significant safety implications when it does occur. New research highlights patterns of opioid and sedative use that are linked to dental visits in under-18s and identifies groups at increased risk of adverse outcomes. The findings add weight to calls for stricter adherence to non-opioid pain management in paediatric dental care.

The issue of pain medication prescription within the context of paediatric dentistry is of vital significance, with a collaborative research team representing the American Dental Association publishing an authoritative report on the matter in 2023. Furthering inquiry into the topic, the new study, which consists mainly of a large retrospective analysis of US insurance claims data, has shed light on how often dentists prescribe high-risk medicines to children and what happens afterwards. The study examined paediatric dental visits over several years, focusing on opioids and benzodiazepines, drugs known to increase the risk of respiratory depression, hospitalisation and longer-term harm when used inappropriately.

Although only a small proportion of dental visits involved these medicines, the consequences were notable. Children who received opioids in connection with dental care were more likely to require follow-up care such as emergency department attendance or hospitalisation shortly after treatment. A subset also went on to demonstrate ongoing opioid use beyond the immediate post-procedure period, raising concerns about early exposure and longer-term dependency risks.

Age emerged as a key factor. Younger children who were prescribed opioids appeared particularly vulnerable to opioid-related harms. This shows that existing professional guidance recommending the usage of non-opioid analgesics need to be adhered to more strictly. The analysis also highlighted higher risks among children with complex chronic conditions, reflecting the added vulnerability of medically complex patients in dental settings.

The type and setting of care mattered as well. Prescribing patterns differed between routine outpatient clinics and hospital-based or specialist services, with more structured environments appearing to offer some protection against adverse outcomes. This may reflect closer monitoring, clearer protocols and greater use of multimodal, non-opioid pain management strategies in specialist or hospital care.

Importantly, the study raises questions about the appropriateness of opioid use for dental procedures associated with limited or mild pain, where evidence supports effective relief using combinations of paracetamol and non-steroidal anti-inflammatory drugs. The findings suggest that inconsistent pain management practices persist, particularly in routine care.

For dental professionals, the message is clear. Safer prescribing in paediatric dentistry depends on guideline-based decision-making, prioritising non-opioid options and ensuring that clinicians have access to relevant medical histories. Strengthening training and standardising pain management approaches could play a crucial role in reducing preventable harm among young dental patients.

The article, titled “High-risk medications in paediatric dentistry”, was published in the December 2025 issue of JADA.