Dental Pain Care

Nonopioid therapy

A recent study found that dentists prescribe 8.6% of all opioids in the U.S. NSAIDs have been found to be more effective than opioids for surgical dental pain.A

Nonopioid therapies are at least as effective as opioids for many common types of acute pain, including dental pain and pain related to a simple dental extraction (Recommendation 1 of the 2022 Clinical Practice Guideline).

Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient (Recommendation 1).

Many acute pain conditions often can be managed most effectively with nonopioid medications. For example:

• Non-steroidal anti-inflammatory drugs (NSAIDs) have been found to be more effective than opioids for surgical dental pain (Recommendation 1).
• The American Dental Association recommends NSAIDs as first-line treatment for acute dental pain management.B

For more specific information visit, nonopioid therapies for pain management.

Opioid therapy

Clinicians should discuss the expected benefits and risks of opioid therapy with patients before prescribing opioids. For more specific information and implementation considerations of the guidance, please refer to Recommendation 1 in the 2022 Clinical Practice Guideline.

When diagnosis and severity of acute pain warrant the use of opioids, clinicians should:

• Prescribe immediate-release opioids (Recommendation 3), at the lowest effective dose (Recommendation 4), and for no longer than the expected duration of pain severe enough to require opioids (Recommendation 6) to minimize unintentional long-term opioid use.
• Advise patients that short-term opioid use can lead to unintended long-term opioid use and of the importance of working toward planned discontinuation of opioid use as soon as feasible.
• To minimize withdrawal symptoms, provide and discuss an opioid tapering plan if opioids will be taken around the clock for more than a few days (Recommendation 6).
• Consider concurrent medical conditions, including sleep apnea, pregnancy, renal or hepatic insufficiency, mental health conditions, and substance use disorders, in assessing risks of opioid therapy (Recommendation 8).
• Offer naloxone when prescribing opioids, particularly if the patient has risk factors for opioid overdose (Recommendation 8).
• Check the prescription drug monitoring program (PDMP) database to ensure a new opioid prescription will not contribute to cumulative opioid dosages or medication combinations that put the patient at risk for overdose (Recommendation 9).
• Use particular caution when prescribing benzodiazepines or other sedating medications with opioid pain medication (Recommendation 11).
• Address concerns with the patient if signs of opioid use disorder (OUD) are present (Recommendation 12).

o Use DSM-5 criteria to assess for the presence of OUD,

o Offer or arrange medication treatment for patients who meet criteria for OUD,

o Use nonpharmacologic and pharmacologic treatments as appropriate to manage pain in patients with OUD.

For additional guidance on treatment and management of acute dental pain, please refer to the American Dental Association's (ADA) clinical practice guideline. To assist in opioid education for dentists, the ADA has a series of webinars that address how dentists have found ways to reduce opioid misuse and educate patients about the benefits and risks of opioid use.