Prescribing Analgesics for Postoperative Dental Pain

It is well-known that there is an opioid crisis in the United States. Prescription opioid analgesics contribute to this crisis; in 2012, dentists ranked second to family care physicians as the top prescribers. The medical and dental literature demonstrates that dental prescribing practices have been excessive, resulting in leftover medication that could then be diverted, misused, or abused. A multimodal analgesic approach is highly valuable in targeting pain along various points on the peripheral and central pain pathways and includes the use of long-acting local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, the last of which are generally reserved for the most severe pain only. The Dental Impaction Pain Model demonstrates that NSAIDs are the frontline drugs for postoperative dental pain. Opioids have their role in postoperative analgesia but should be reserved for severe breakthrough pain or in situations where NSAIDs may be contraindicated.