Please see the second article of the Spring 2026 issue!

Background: The frequency of opioid and antibiotic prescribing for pediatric patients presenting to emergency departments (ED) for dental pain without overt infection is not well known. The aim of this study is to analyze ED prescribing patterns for the treatment of “simple toothache” in children.

Methods: This was a retrospective, cohort analysis of consecutive pediatric patients (ages 1-19 years) diagnosed with dental pain without trauma or obvious infection (defined as fever, intraoral or extraoral swelling, purulence, or trismus). Patients were seen at seven emergency departments (ED) over a 4-year study period (2018-2021). Clinical findings, treatment in the ED, and final disposition were recorded using an institutional honest broker system. Our study hypothesis was that both opioids and antibiotics are overutilized for the ED treatment of simple toothache in children. Descriptive statistics (frequency tables, confidence intervals) were used to summarize the data.

Results: A total of 683 pediatric patients met the inclusion criteria. The average age was 11.6 + 5.8 years. The 17- through 19-year age group had the highest rate of dental-related ED visits (33.1%). A higher proportion of Medicaid beneficiaries (66.6%) had dental visits compared with the commercially insured (26.9%) or uninsured (6.5%). Virtually all patients had a documented primary care physician (99.0%). The most common diagnoses were nonspecific odontalgia (55.4%) or dental caries (33.7%). An antibiotic, most often amoxicillin or penicillin, was prescribed in 60.1% (95% CI 57.3% to 64.7%) of ED visits. Opioids, most often hydrocodone, were prescribed in 18.7% (95% CI 15.9% to 21.9%). Dental nerve blocks were performed in only 43 patients (6.3%). Twelve percent of patients returned within 7 days requesting further analgesia.

Conclusion: The ED is a well-known safety net for children with a simple toothache who have no direct access to dental care. However, the recommended treatment for these patients are usually dental procedures rather than antibiotics or narcotics. Data-driven solutions, such as guideline implementation, provider education, use of nonsteroidal anti-inflammatory drugs, and dental nerve blocks could reduce medication-related harms and avert health care expenditures.