Dental Pain Care

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline) provides evidence-based recommendations to support clinicians including dentists and other oral health practitioners. A recent study found that dentists prescribe 8.6% of all opioids in the U.S., and the 2022 Clinical Practice Guideline provides recommendations for dentists and other oral health practitioners to effectively manage acute pain conditions including mild postoperative pain resulting from a simple dental extraction.¹

Pain Management Options

Opioid Therapy

Clinicians should discuss the realistic benefits and known common risks of opioid therapy and nonopioid therapies with patients before prescribing opioids. For more specific information, 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 1 and Recommendation 5).
• 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).
  • Use DSM-5 criteria to assess for the presence of OUD,
  • Offer or arrange medication treatment for patients who meet criteria for OUD,
  • Use nonpharmacologic and pharmacologic treatments as appropriate to manage pain in patients with OUD.