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Resources  |  Opioid Pain Management

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 for additional patient resources.