Acute Care Opioid Treatment and Prescribing Recommendations: Dental
Opioid prescriptions should not be written prior to completing a dental procedure.
Communicate a conservative philosophy by emphasizing the efficacy and appropriateness of over the counter medications’ analgesic properties.
Address dental pain through clinical intervention rather than opioid pain relief.
Refer patients to a free or low-cost dental program in the absence of insurance or financial constraints.
The prescription drug monitoring program (PDMP) must be accessed prior to prescribing controlled substances schedules 2-5, in compliance with Michigan law.
Conduct full dental and medical history of the patient and include analysis of current medications.
Identify any high-risk behaviors or diagnoses (previous substance use disorders, alcohol or tobacco use, psychiatric comorbidities including depression or anxiety).
Non-opioid therapies (e.g., acetaminophen, ibuprofen) should be encouraged as the primary treatment.
Non-pharmacologic therapies (e.g., acupuncture, mindful practice) should be encouraged when the patient is open to these alternative solutions to pain control.
For breakthrough or severe pain, short-acting opioids (e.g., hydrocodone, oxycodone) should be prescribed at the lowest effective dose for no more than 3-5 day courses.
Do not co-prescribe opioids with other sedatives or CNS depressant medications (e.g., benzodiazepines).
Consider offering a naloxone co-prescription to patients who may be at increased risk for overdose, including those with a history of overdose, a substance use disorder, those already prescribed benzodiazepines, and patients who are receiving higher doses of opioids (e.g., >50 MME/Day).
For patients discharged with an opioid prescription
Discuss the expectations regarding recovery and pain management goals with the patient.
Educate patient and parent/guardian (for minors) regarding safe use of opioids, potential side effects, overdose risks, and developing dependence or addiction as required by Michigan law.
Emphasize not using opioids concomitantly with alcohol or other sedative medications (e.g., benzodiazepines).
Educate patient on tapering of opioids as dental/oral pain resolves.
Refer to Michigan-Open.org for additional patient resources.