Comparison of Dental Benzodiazepine Prescriptions From the U.S., England, and Australia From 2013 to 2018


      Benzodiazepines contribute to substance use disorder and are often part of polydrug abuse, most frequently with opioids. Although dental opioid prescribing differs significantly between countries, little is known about the patterns of dental benzodiazepine prescribing. The aim of this study is to compare dental prescribing of benzodiazepines among the U.S., England, and Australia in 2013–2018.


      Population-level data were accessed from national data sets for each country for dental benzodiazepine prescriptions. Outcome measures of dental benzodiazepine prescribing included: (1) prescribing rates by population for each year and (2) the quantity and relative proportion of benzodiazepines by type for each country. The analysis was conducted in 2020.


      Between 2013 and 2018, U.S. dentists prescribed 23 times more than English dentists and 7 times more than Australian dentists by population. During the study period, the rate of dental benzodiazepine prescribing decreased in England and the U.S. but increased in Australia. Despite these trends, U.S. dental prescribing rates remained 28 times more than English dentists and 6 times more than Australian dentists in 2018 (U.S., 3.10 prescriptions/1,000 population; England, 0.11 prescriptions/1,000 population; Australia, 0.50 prescriptions/1,000 population). U.S. dentists prescribed a wider variety of benzodiazepines than English and Australian dentists. Diazepam was most commonly prescribed in all countries. In the U.S., triazolam, lorazepam, and alprazolam were next most commonly prescribed. Temazepam was next most frequent in England and Australia.


      Significant variation in benzodiazepine prescribing rates and types were seen among the countries. To improve patient safety, further investigation into the appropriate use and choices of benzodiazepines in dentistry is needed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Calcaterra SL
        • Severtson SG
        • Bau GE
        • et al.
        Trends in intentional abuse or misuse of benzodiazepines and opioid analgesics and the associated mortality reported to poison centers across the United States from 2000 to 2014.
        Clin Toxicol (Phila). 2018; 56: 1107-1114
        • Dobbin M
        Pharmaceutical drug misuse in Australia.
        Aust Prescr. 2014; 37: 79-81
        • Longo LP
        • Johnson B
        Addiction: part I. Benzodiazepines–side effects, abuse risk and alternatives.
        Am Fam Physician. 2000; 61 ( Accessed March 24, 2021): 2121-2128
        • Gold MS
        • Miller NS
        • Stennie K
        • Populla-Vardi C
        Epidemiology of benzodiazepine use and dependence.
        Psychiatr Ann. 1995; 25: 146-148
        • Friedrich JM
        • Sun C
        • Geng X
        • et al.
        Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data.
        Clin Toxicol (Phila). 2020; 58: 725-731
        • Bachhuber MA
        • Hennessy S
        • Cunningham CO
        • Starrels JL
        Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996-2013.
        Am J Public Health. 2016; 106: 686-688
      1. Benzodiazepine drug class: drug safety communication—boxed warning updated to improve safe use.
        U.S. Food and Drug Administration, 2020 ( Updated September 23, 2020. Accessed February 12, 2021)
        • Oral and Dental Expert Group
        Therapeutic Guidelines: Oral and Dental Version 3.
        Therapeutic Guidelines Ltd, Melbourne, Australia2019
        • NHS Education for Scotland, Scottish Dental Clinical Effectiveness Programme
        Conscious sedation in dentistry: dental clinical guidance.
        third edition. NHS Education for Scotland, Scottish Dental Clinical Effectiveness Programme, Dundee, Scotland2017 (Published June)
      2. Dental Practitioner's Formulary, British National Formulary. Accessed March 24, 2021.

        • Scottish Dental Clinical Effectiveness Programme
        Drug prescribing for dentistry: dental clinical guidance.
        third edition. Scottish Dental Clinical Effectiveness Programme, Dundee, Scotland2016 ( Accessed March 24, 2021)
        • NHS National Statistics
        Access and Barriers to Care—a Report From the Adult Dental Health Survey.
        2009 ( Published 2011. Accessed August 1, 2020)
        • von Elm E
        • Altman DG
        • Egger M
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Equator Network, Enhancing the Quality and Transparency of Health Research.
        2019 ( Updated October 22, 2019. Accessed October 1, 2020)
      3. Population. U.S. Census Bureau. Accessed August 1, 2020.

      4. Prescription cost analysis – England, 2017 [PAS]: National statistics. NHS Digital.
        2019 (Updated October 10)
      5. Population Estimates. Office of National Statistics. Accessed August 1, 2020.

      6. PBS and RPBS Section 85 Date of Supply Data. Australian Government Department of Health. Accessed August 1, 2020.

      7. The Pharmaceutical Benefits Scheme, browse by dental items. Australian Government Department of Health. Updated March 1, 2021. Accessed August 1, 2020.

      8. Australian Statistics on Medicines. Australian Government Department of Health. Accessed August 1, 2020.

      9. Australian Bureau of Statistics. Australian Government. Accessed August 30, 2020.

        • The National Archives
        Open Government Licence for Public Sector Information.
        2019 ( Accessed August 1, 2020)
        • Blinkhorn AS
        Comparison of the dental health of adults and children living in NSW with their counterparts in the U.S. and UK.
        N S W Public Health Bull. 2009; 20: 52-55
        • Mejia GC
        • Elani HW
        • Harper S
        • et al.
        Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States.
        BMC Oral Health. 2018; 18: 176
        • Slade GD
        • Nuttall N
        • Sanders AE
        • Steele JG
        • Allen PF
        • Lahti S
        Impacts of oral disorders in the United Kingdom and Australia.
        Br Dent J. 2005; 198: 489-493
        • Suda KJ
        • Durkin MJ
        • Calip GS
        • et al.
        Comparison of opioid prescribing by dentists in the United States and England.
        JAMA Netw Open. 2019; 2e194303
        • Teoh L
        • Hollingworth S
        • Marino R
        • McCullough MJ
        Dental opioid prescribing rates after the up-scheduling of codeine in Australia.
        Sci Rep. 2020; 10: 8463
        • Ait-Daoud N
        • Hamby AS
        • Sharma S
        • Blevins D
        A review of alprazolam use, misuse, and withdrawal.
        J Addict Med. 2018; 12: 4-10
        • Rush CR
        • Higgins ST
        • Bickel WK
        • Hughes JR
        Abuse liability of alprazolam relative to other commonly used benzodiazepines: a review.
        Neurosci Biobehav Rev. 1993; 17: 277-285
        • Jackson DL
        • Johnson BS
        Conscious sedation for dentistry: risk management and patient selection.
        Dent Clin North Am. 2002; 46: 767-780
        • Flick W
        • Lloyd M
        Illinois dental anesthesia and sedation survey for 2016.
        Anesth Prog. 2019; 66: 77-86
        • Maguire WS
        • Lewney J
        • Landes DP
        A comparison of the sedation provision of NHS dental services 2014‒2016 for local authorities throughout England.
        Br Dent J. 2019; 227: 497-502
        • Conscious sedation
        Australian Health Practitioner Regulation Agency, Dental Board of Australia.
        2019 ( Updated February 2, 2019. Accessed December 15, 2020)
        • Dental Board of Australia
        Registrant data. Australian Health Practitioner Regulation Agency.
        2020 ( Accessed December 6, 2020)
        • Hoffmann RG
        • Kotchen JM
        • Kotchen TA
        • Cowley T
        • Dasgupta M
        • Cowley Jr., AW
        Temporomandibular disorders and associated clinical comorbidities.
        Clin J Pain. 2011; 27: 268-274
        • de Souza IF
        • Mármora BC
        • Rados PV
        • Visioli F
        Treatment modalities for burning mouth syndrome: a systematic review [published correction appears in Clin Oral Investig. 2019;23(9):3657].
        Clin Oral Investig. 2018; 22: 1893-1905
        • Burning mouth syndrome
        The American Academy of Oral Medicine.
        2015 ( Updated January 22, 2015. Accessed December 15, 2020)
        • National Health Service
        How Should Dentists Prescribe, Store, Order and Dispose of Controlled Drugs?.
        2016 ( Accessed August 1, 2020)
      10. The poisons standard (the SUSMP). Australian Government, Department of Health, Therapeutic Goods Administration. Accessed December 13 2020.

        • Teoh L
        • Marino RJ
        • Stewart K
        • McCullough MJ
        A survey of prescribing practices by general dentists in Australia.
        BMC Oral Health. 2019; 19 ( Accessed March 24, 2021): 193