Recommended Opioid Policy for Dentists

Pain management is routinely required for some dental procedures. Patients must receive respectful care and appropriate management of dental pain. Most often, dental pain management is for acute or episodic situations, requiring short-term prescribing. For many conditions, ibuprofen, acetaminophen, or a combination of the two will suffice for dental pain. In other circumstances, a very small amount of narcotic medications followed by OTCs will provide appropriate pain relief.

1. Prescribe opioids cautiously to those with a substance-abuse history. Be aware that such use can trigger relapse behaviors in susceptible individuals.
2. Ask if patients are getting medications from other doctors, and use the PDMP prior to prescribing opioids whenever possible.
3. Do not prescribe opioids to patients in substance-abuse treatment programs without consulting the program’s medical staff.
4. Do not offer prescriptions with refills. Use caution if replacing prescriptions that were lost, destroyed, or stolen.
5. Prescribing over the phone is discouraged, especially with patients you have not met, except in rare cases involving known invasive surgery.
6. The use of non-combination opioids is discouraged.
7. Prescribe opioid pills only in small dosages, which in most cases should not exceed three days or 10 tablets.
8. When prescribing an antibiotic with the opioids, stipulate that the narcotic must be filled with the antibiotics at the pharmacy.
9. Inform patients how to secure medication against diversion and how to dispose of leftover medication.
10. Opioids should not be prescribed more than seven days after the last appointment. In most cases, three days of medication will suffice. It is strongly recommended that the patient be assessed in the clinic prior to providing refills.
11. A second refill (same or different opioid) request should require patient assessment in the dental clinic and only be provided once a supporting diagnosis is established to continue with narcotic pain management.
12. Third refills are strongly discouraged (except in unusual clinical circumstances that are well documented, such as osteonecrosis management); consider the need for chronic pain management by physician.
13. Prolonged pain management (while awaiting specialty care) should be managed by and/or coordinated with the patient’s primary care provider.